|Oral Rehydration Therapy and the Control of Diarrheal Diseases (Peace Corps, 1985, 566 pages)|
|Module Two: Diarrhea, dehydration and rehydration|
|Session 5 - Rehydration therapy|
Whether a country is producing ORS locally or using UNICEF sachets, the product must be properly stored so that it remains effective from the time it is delivered to the central store to the moment it is used. Sodium bicarbonate causes decomposition of glucose in oral rehydration salt mixtures. High temperatures and humidity may accelerate this process and manufacturers must consider these factors when preparing and packing ORS.
· Temperatures in buildings where ORS is stored should not exceed 30°C. Above this temperature the ORS may melt or turn brown. If this happens, it may be very difficult to dissolve and should not be used. If, however, it has only turned yellow, as long as it can be properly dissolved, it is still safe to use and effective.
· Supplies of ORS should not be stored in buildings with galvanized roofs directly exposed to the sun without adequate ventilation. These rooms get very hot.
· Humidity in stores should not exceed 80 per cent. In higher humidity the ORS is likely to cake or turn solid. Increase ventilation and avoid standing water in or near storage rooms.
· As far as possible, storage areas should be cleared of insects and rodents.
· Packets should be packed so they are protected from puncturing by sharp objects.
· UNICEF recommend storing their ORS sachets in stacks of cartons approximately 1 to 1 1/2 metres high.
· A rotating system should be introduced so that the oldest ORS (identified by date and batch number) is used first. When in a hurry, avoid distributing the packets which are at the front of the top unless you are sure they are the oldest in the store.
· Regional storage areas should be located in places that will be convenient for subsequent distribution.
Regular inspection of packets
· Laminated foil ORS packets have an estimated shelf life of at least three years. Note the production date on the label. Packets of ORS must be checked regularly (every three months) to see if the quality is still acceptable. Open at least one packet in each batch to see if ORS is usable. Locally produced packets of ORS is usable. Locally produced packets of ORS are often packaged in plastic and will probably have shorter shelf life. It is especially important to check them regularly.
· Check ORS packets in any boxes that appear to be damaged. Open at least one packet from the top, middle and bottom of the box to see if the ORS is still usable.
Keeping records at each point where ORS is received and delivered
· Records should show:- the quantity, batch number or letter, and date received.
- the quantity and date issued (i.e. sent from one point in the distribution system to another).
- the amount currently in stock.
- stock level at which a new supply should be requested.
· Records should also indicate any problems (such as spoilage due to a leaking warehouse).
· Supplies should be counted every three months and results compared with quantities shown in the records.
· The evaluation of stock is an important factor in determining future quantities of ORS required.
If you are interested in further information on local production of ORS and quantity control, the following publications are available from the Programme Manager, CDD Programme, World Health Organization, 1211 Geneva 27, Switzerland.
· Guidelines for the production of oral rehydration salts.
· Good practices for the manufacture and quality control of drugs.
(From: Diarrhoea Dialogue, Issue 8, February 1982, p.6)