Credited to Bangladesh. Researchers at the Johns Hopkins center in Calcutta, India, worked on oral rehydration at the same time and share credit in many accounts. The Dhaka laboratory is credited with the first successful clinical trial, published in 1968.
How it began
The Cholera Research Laboratory was set up in Dhaka in 1960 and later became icddr,b. American and Bengali scientists there looked for a way to treat cholera without intravenous drips. By April 1968 they had shown that an oral solution of glucose and sodium could maintain the fluid balance of cholera patients. The trial, by David Nalin, Richard Cash, Rafiqul Islam and colleagues, appeared in The Lancet in 1968.
Before it existed
Untreated cholera killed 30 to 40 percent of patients through the mid-20th century. The only treatment was intravenous fluid, which needed sterile equipment and trained staff and was too costly and difficult to give to large numbers of people in an outbreak. An earlier attempt at oral rehydration in the Philippines failed because the sugar and salt solution was too concentrated.
How it works
The gut can still absorb fluid during severe diarrhea when salts and glucose are present in the right balance. The solution is made of glucose, sodium chloride, sodium bicarbonate and potassium chloride dissolved in clean drinking water. Drinking it reverses the loss of water and electrolytes and reduces the need for intravenous fluid.
How it spread
Within a decade of the Dhaka trial, the World Health Organization, UNICEF, the UN Development Programme and other organizations promoted the solution and delivered millions of sachets a year worldwide. From the late 1970s its use spread across low-income countries.
What lasted
In August 1978 The Lancet called oral rehydration "potentially the most important medical advance of this century". icddr,b estimates that it has saved the lives of 70 million children. Before it, diarrhea caused at least five million deaths a year among children under five.
Where it stands today
Coverage is uneven. Bangladesh had mean coverage of 76.2 percent in 2017, but UNICEF reported in 2016 that fewer than half of children under five with diarrhea in low and middle income countries received the solution. Diarrheal disease still caused about 480,000 deaths of young children a year as of 2019.
