Staple Food Based
Oral Rehydration Solutions
Sukwan Handall*, Hao Llying*, Martha Kombong**, Ata Nalun***
* District Health Office, PO Box 108, Wamena 99501
** Irian Jaya Training, World Vision International, Wamena
*** Regional Health Laboratory, Jayapura
INTRODUCTION
Diarrhea is still one of the major killers of children under five
in the Central Highlands of Irian Jaya. One of the causes of this
high mortality is related to the delay of the treatment for the
dehydrated children.
To overcome this problem, Sugar Salt Solution (SSS) and
even WHO-UNICEF Oral Rehydration Salt Solution (ORS)
have been used for home-based treatment for early diarrhea with
or without dehydration. Unfortunately, these solutions do not
shorten the duration of diarrhea and/or decrease stool's volume
and do not encourage parents to rely on these solutions only(
1-6)
.
Rice-based oral rehydration solution was developed in some
countries and the benefits of this solution have been proven by
several studies
(1-6)
. Unfortunately, rice is a luxurious thing and
not always available for the people in the Central Highlands of
Irian Jaya where sweet potato, banana, sago and corn are their
staple foods.
Developing staple food-based oral rehydration solutions in.
the Central Highland will benefit the community.
MATERIALS AND METHODS
Preparation of the materials
Sweet potato (Ipoema batatas) and banana (Musa domes-
tica) were peeled, then sliced very thin and dried under the sun for
4 hours. The dried slices of sweet potato, banana and corn were
pounded with a simple wood mortar. The powder produced was
dried again under the sun for 4 hours. The powder yielded from
sweet potato, corn and banana were 19.2%, 20,8% and 18.2%,
respectively.
Fifty grams of each powder boiled and stirred with distilled
water for about 20 minutes [added until 1 liter of solution] and
cooled in the air. Then all the samples were centrifuged, using
Heuich EBA 3S in 1000 rpm for 5 minutes. The supernatants
were taken and two samples were prepared from each kind of
powder.
Measurement of Sodium, Potassium and Glucose
1)
Sodium and Potassium (Flame photometer method)
A standard solution (140 mmol/l of Sodium and 5 mmol/lof
Potassium) was prepared (4 ml distilled water and 200 µl stan-
dard solution).
Two samples of 200µl materials each were added into 4 ml
distilled water. As the concentration of sodium was low, the
solution was not diluted further. But, for potassium measure-
ment, dilution of 2 times was made.
The concentrations of sodium and potassium were examined
by a 400 flame photometer [Corning Medical, England], with
Acetylene gas pressure 1 kg/cm
2
.
2)
Glucose (GOD-PAP method [Boehringer Manheim])
A standard solution was made (100 µl standard solution and
23 ml Reagent Glucose). Two samples of 10µl materials each
added to 2.5 ml Reagent Glucose. All the materials were warmed
at 37°C for 15 minutes in Waterbath model YB-131 (American
Scientific Products). All materials absorbences were examined
on Spectronic 21, (Bausch & Lomb) with filter 610 nm.
RESULTS
The concentrations of sodium, potassium and glucose in
each sample were quite similar, except of the concentration of
glucose in sweet potato (yellow). Banana has the highest sodium
in the solution, and the potassium was not much different. Corn
has the lowest sodium and potassium concentration.
Compared with the WHO-UNICEF Oral Rehydration Salt
solution, all the staple food-based Oral Rehydration Solutions are
hyponatremic, hypokalemic, and hyperglycemic (except yellow
sweet potato, which is a hypoglycemic solution). Unfortunately,
the osmolarity of the solution were not examined so comparisons
could not be made with the WHO-UNICEF ORS (Table 1).
Table 1. Concentrations of Sodium, Potassium and Glucose
Staple Food
Sodium
(Mmol/l)
Potassium
(Mmol/l)
Glucose
(mg %)
Sweet potato, white
15.6 23.7
9.8 11.6
174 175
Sweet potato, yellow
28.0 37.3
8.7
47 49
Corn 9.3
3.7
112
113
Banana
WHO-UNICEF
37.3 46.6
7.5
168 171
Oral Rehydration
Sa1ts
(7,8)
90 20 111
Rice Fluor Solution
(3)
1.4 2.0
DISCUSSION
The sodium content of the solutions examined in this study
did not differ very much from the concentration of sodium in
Sugar-Salt Solution and was in the safety range of oral rehydra-
tion therapy used for home-treatment
(2)
. Compared with a study
of Rice Flour Solution
(3)
, the sodium content in banana, corn and
sweet potato solutions are higher. It means that the risk of
hyponatremia with sweet potato, corn or banana solutions will be
less than that of Rice-based Oral Rehydration Solution and the
risk of hypernatremia is lower than WHO-ORS
(8)
.
The glucose content in corn is acceptable according the
glucose content of home-made Sugar-Salt Solution and WHO-
UNICEF ORS
(2,7,8)
. The other solutions have higher glucose
content and this might be related to an increase of osmolarity
(6)
.
Unfortunately, osmolarity of these solutions were not examined.
Although glucose (monosaccharides and dissacharides) increased
the osmolarity, starch in its polymeric form was found in the
solution which decreased the osmolarity
(6)
, so the osmolarity
might not be so high in these solutions. The high content of
glucose in the solutions (except yellow sweet potato and corn)
does not discourage the use of these solutions as the maximum
glucose that can be absorbed in acute diarrhoea is around 2%. If
the concentration was over 2%, it may cause osmotic diarrhoea
(2)
.
Besides those materials, the solutions could have some
amount of protein, dipeptides, neutral amino acids or hydrolysed
proteins which help to couple and to enhance the absorption of
natrium and then, osmotically, water flow in the same direction
(1)
.
All of the contents found in the study of these solutions made
these staple food-based oral rehydration solutions suitable to be
used as home-treatment of diarrhoea with or without dehydra-
tion.
Although preparing powders from the staple food are time-
consuming, the benefit of preparing the powder does not only lie
in using the powder as a home-based oral rehydration solution,
but also can be used as the weaning food for babies in the Central
Highland of Irian Jaya.
A further study is needed to assess the impact of these staple
food-based oral rehydration solutions use in the treatment of
dehydration among children under five in the highlands of Irian
Jaya.
CONCLUSION
The staple food (sweet potato, corn and banana)-based oral
rehydration solutions have quite similar contents of minerals and
glucose as in Sugar-Salt Solution, Rice-based Oral Rehydration
Solution and WHO-UNICEF ORS.
ACKNOWLEDGEMENT
We thank Dr. Yenni, Head of Health Laboratory Department in Jayapura
for the permission to use the laboratory, Ms. Andy Hajrah and Ms. Kamla for
assisting on the measurement Sodium, Potassium and Glucose concentration.
We also appreciate the help of Dr. B. Sandjaja MS(PH) and Dr. Budi
Subianto MPH, Provincial Health Office for their suggestions and critics. We
also thank Sue Trenier RN for English language corrections.
REFERENCES
1.
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2.
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Mota-Hemandez F, Bross-Soriano D, Perez-Ricardez ML. Velasquez-Jones
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4.
Gore SM, Fontaine 0, Pierce NF. Impact of rice based oral rehydration
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clinical trials. BMJ 1992; 304: 28791.
5.
Anonymous. Solving the weanling's dilemma: power-flour to fuel the gruel?
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7.
ME Avery et al. Oral Therapy for Acute Diarrhea: the underused simple
solution. NEJM 1990; 323(13): 8913.
8.
Gracey M. Oral therapy for acute diarrhoea. Med 'Austral 1984; 140: 348-9.
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