Experience in running a Diarrhoeal Training cum Treatment Unit (DTTU) in a state teaching hospital in Calcutta.

The performance of the Diarrhoeal Training cum Treatment Unit (DTTU) of NRS Medical College and Hospital, Calcutta, in a 2-year period was evaluated by record analysis. The study revealed that 73.6% cases out of a total 4349 could be successfully managed at the oral rehydration therapy (ORT) area and only 16.5% cases required indoor admission. Rest of the cases (9.9%) with "no dehydration" were sent home with advice. There were 84.7% cases out 3919 dehydration cases who could be successfully treated by ORT and only 15.3% required intravenous (i.v.) therapy. A definite decline was also evident in the proportion of diarrhoea cases requiring antibiotic therapy (13.5% in 1991 to 6.8% in 1992). The case fatality rate due to diarrhoea was 1.7% in 1992. Had all cases of diarrhoea with dehydration being admitted and treated with i.v. fluids and antibiotics, the estimated cost would have been Rs 14.2 lakhs, which with ORT, actually cost Rs 2.4 lakhs. Thus estimated total cost reduction was to the extent of Rs 11.8 lakhs in a 2-year period.

PIP: The Diarrheal Training with Treatment Unit (DTTU) was established in the Department of Pediatrics, NRS Medical College and Hospital, in Calcutta, India, in 1990, to promote use of oral rehydration therapy (ORT) in diarrhea in children 0-5 years of age. To evaluate the success of this effort, a retrospective review was conducted of the 4349 child diarrhea cases presenting to DTTU in 1991-92. 3919 children (90.1%) were dehydrated at admission; the nondehydrated cases received counseling only and were discharged. 3202 children (73.6%) with diarrhea-related dehydration were successfully treated with ORT; intravenous fluids were administered in 598 (15.3%) of these cases. 717 children (16.5%) required hospital admission; 83.4% of these children received intravenous fluids. The proportion of diarrhea cases requiring antibiotics decreased from 13.5% in 1991 to 6.8% in 1992. Case fatality was 1.8% in 1991 and 1.7% in 1992. The actual cost of treatment was Rs. 1,50,048 in 1991 and Rs. 91,178 in 1992. These amounts represent savings of Rs. 6,00,912 and 5,77,867, respectively, over what would have been the costs if all cases had been treated on an inpatient basis with intravenous fluids and antibiotics. These findings confirm the effectiveness of DTTU's strategy of ORT management of children with diarrheal dehydration combined with proper training and motivation of both mothers and health workers.