Oral Rehydration Salts (ORS) – a cheap and effective treatment for diarrhoea -- can save the lives of half a million children every year, according to a study.

A whopping 500,000 children under five die from diarrhoea globally. India accounts for the most cases of child diarrhoea of any country in the world. It is also a leading cause of child death in India.

ORS, which comes in a small packet and dissolves in water, is a lifesaving and inexpensive treatment for diarrhoeal disease, yet few prescribe it.

To understand the reason behind this underprescribing of ORS, researchers at the University of Southern California (USC) conducted a survey of about 2,000 healthcare providers in over 200 towns in Bihar and Karnataka.

The findings, published in the journal Science, reveal that 50 per cent of children with diarrhoea in India do not receive ORS. It is due to provider misperceptions that patients do not want ORS. It plays the biggest role in underprescribing of ORS.

Healthcare providers’ perception that patients do not want ORS accounted for roughly 42 per cent of under-prescribing, while stockouts and financial incentives explained only 6 per cent and 5 per cent, respectively.

“Even when children seek care from a health care provider for their diarrhoea, as most do, they often do not receive ORS, which costs only a few cents and has been recommended by the World Health Organisation for decades,” said Neeraj Sood, from the USC Schaeffer Center for Health Policy & Economics and a professor at the USC Price School of Public Policy.

“Despite decades of widespread knowledge that ORS is a lifesaving intervention that can save lives of children suffering from diarrhoea, the rates of ORS use remain stubbornly low in many countries such as India,” added Manoj Mohanan, Professor of public policy, economics, and global health at the Sanford School of Public Policy at Duke University.

For the study, the researchers selected states with vastly different socioeconomic demographics and varied access to health care to ensure the results were representative of a broad population.

Bihar is one of the poorest states in India with below-average ORS use, while Karnataka has above-average per capita income and above-average ORS use.

Patients expressing a preference for ORS increased prescribing of the treatment by 27 percentage points — a more effective intervention than eliminating stockouts (which increased ORS prescribing by 7 percentage points) or removing financial incentives (which only increased ORS prescribing at pharmacies).

"Changing provider behaviour about ORS prescription remains a huge challenge," Mohanan said.