http://doi.org/10.33698/NRF0143  Mamita, Sushma Kumara Saini, Kanita

Abstract: Children are the most vulnerable group of the society. Their health is always at a risk due to various reasons. The major factor in maintaining the good health status of children is the maintainence of the hydration status of their body which can be achieved through regular consumption of fluids and electrolytes such as sugar-salt drinks. Keeping this view in mind the present study was conducted to assess the effect of consumption of home made sugar salt drink on health status of children (3-6 years) residing in Dadu Majra Colony, U.T., Chandigarh. The children aged 3-6 years were identified for the study and were randomized into experimental and control group. For continous 1 month home made sugar salt drink was administered to the subjects of experimental group. The pre and post intervention health assessment of children in both groups was done. Descriptive and inferential statistics (chi square test,& odds ratio) were calculated through SPSS. The control group subjects had 7 times higher odds of having any illness episode during the intervention than experimental group. About 85% of the subjects in experimental group did not have a single episode of any acute illness during the intervention. The experimental group subjects reported a improved general appearance and tongue texture during the intervention (p<0.05).Thus the study concluded that the regular consumption of home made sugar salt drink is effective in maintaining the health status of child, meets the daily requirements of water, electrolytes, maintains the hydration status of body & reduces the episodes of illness.

Key-words

Home made sugar salt drink, Health status of Children

Correspondence at: Mamta Lecturer  Silver Oaks College of Nursing,Village Abhipur, District: Mohali, Punjab
Introduction:Adequate water and electrolyte intake is very necessary for survival and health promotion of children.1 The standard recommendation of water intake for children is at least 6-8 glasses (1.5-2 litres) a day. 2-5 The body maintains a proper water balance through action of electrolytes like sodium, potassium and chloride which maintain the water movement inside and outside the cells of the body thus helps to keep the body hydrated.1,Along with consumption, proper absorption and secretion of water and electrolytes is very much necessary. Any change in the two-directional flow of water and electrolytes results in water and electrolyte imbalance which further leads to various health problems like dehydration, acute respiratory tract infection, pneumonia, cough and cold, sore throat, constipation, urinary problems, poor nutritional status, heat illnesses/stroke and skin problems etc. (9-10) One very effective measure to maintain the hydration status of child is the use of home made sugar salt solution/drink. It can be made at a home by using 1 glass of water (200 ml) with 1 finger pinch of salt and 1 levelled teaspoon of sugar with 2 drops of lemon juice. It is simple to prepare, does not require cooking, very cost effective, easy to digest and can be given to child in case of emergency as well.(9-14) It is quite helpful in maintaining hydration level of body, reduces child morbidity and mor tality, balances the electrolyte levels of body,(14, 15) leads to weight gain (16-17).The literature speaks about the benefits of consumption of adequate water along with electrolytes in the form of sugar salt drink in the maintainence of health status but there is lack of evidence base to prove this. So the present study was carried out with the objectives to assess the effectiveness of daily regular intake/ consumption of home made sugar salt drink on the health status of children.

MATERIALS AND METHODS:

Randomized control trial was conducted from July 2010-september 2010 in Dadu Majra Colony, U.T., Chandigarh which is a resettled colony which habitats migrants from Punjab, Haryana, U.P, Himachal Pradesh etc. Participants included in the study were children aged 3-6 years. The children who were having any congenital abnormality and whose parents did not give the consent for the study were not included in the study.Tools for data collection were prepared before hand which consisted of a health assessment proforma assessing the parameters related to anthropometry, vital signs, parameters of clinical dehydration scale (general appearance, tongue texture, eyes), urinary parameters and any health problem during last 1 month. A procedure protocol was prepared for the preparation of sugar salt drink at home. For assessing the proficiency of preparation of drink a checklist was also prepared. The validity of these tools was estabilished by seeking opinion of experts from the field of nursing, community medicine and pediatrics. The reliability of the tool was assessed using test retest method. Permission to conduct the study was obtained from the competent authorities. For the study purpose the whole area of Dadu Majra Colony was divided into two parts divided by the main road passing through the middle of the colony. Then through lottery method, area was chosen for experimental and control group. This was done to prevent the contamination between experimental and control group. Then table of random number was generated for each group. These generated numbers were the house numbers of the experimental and control group. Then researcher identified and enrolled the children (3-6) years with the help of those generated house number after taking the consent from the parents. Total sample size was 120: experimental group, 60: control group 60. The pre health assessment of children in both groups was done with health assessment proforma. Then the parents of subjects of experimental group were demonstrated the preparation of home made sugar salt drink. This drink was administered to children once a day for continous one month under the supervision of either investigator or parents. Before administering the drink, parent’s proficiency of preparing drink was checked with help of checklist. Initially for 1st week daily monitoring of subjects was done followed by alternate day monitoring. Daily recording of consumption of sugar salt drink by the child was done in the recording sheet. Finally after one month of intervention the health assessment of both groups was done and compared.The data was analyzed using SPSS. Mean, S.D, Chi square and Odds ratio were calculated. Intention to treat analysis was done.

RESULTS:A total of 120 children (60: experimental group, 60: control group) were enrolled in the study. The mean age+ S.D. of the subjects was 51.95 + 9.409 months and 49.62 + 8.980 months in experimental and control group respectively with range between 36- 70 and 36-69 months. Experimental group had higher proportion of males (60%) as compared to control group. As per the family size and family type is concerned both the groups had same kind of distribution. The mean per capita income was Rs. 921.08+561.84 for experimental group and Rs. 1146 +723.48 for control group. About 88% of subjects were Hindu in experimental group whereas in control group 97% of the subjects belonged to Hindu families. 85% of the subjects in experimental group were from Schedule caste whereas about 95% of the subjects in control group were from same category. Both the groups were found to homogeneous in nature as for all the socio demographic variables p value is >0.05.Table -1.About 85% of the subjects in experimental group did not had even a single episode of any illness during the intervention (p value=0.001) whereas in control group about 45% of the subjects had at least 1 episode of any illness (p value=0.085) (Table 2) Comparison of frequency of common childhood illnesses in experimental and control group in pre and post intervention phase showed that there was a decrease in the total number of cases of these illnesses in the experimental group. During the intervention there was only 1 case of vomiting, fever cases had been decreased from 13 % to 7%, constipation cases decreased from 13% to 0%, diarrhea/ dysentery cases decreased from 6% to 0%. There was not even a single case of rhinitis,cough and burning micturition during the intervention in experimental group whereas in the control group the pre and post intervention results were almost same. (Table 3)

Table 1: Socio-demographic data of the subjects in experimental and control groups

 

Variable Experimental Group Control Group x²
(n=60) n (%) (n=60)n (%) df P value
Age in month*
36-48 20(33.3) 28(46.7) 2.297
48-60 25(41.7) 21(35.0) 2
60-72 15(25.0) 11(18.3) 0.317
Sex of child 0.845
Male 36(60.0) 31(51.7) 1
Female 24(40.0) 29(48.3) 0.358
Total number of family members
1-5 37(61.7) 38(63.3) 0.213
6-10 20(33.3) 20(33.3) 2
Family type in which child is living 0.035
Nuclear 24(40.0) 23(38.3) 1
Joint 36(60.0) 37(61.7) 0.852
Per Capita Income (‘Rs’)”
100-500 16(26.7) 15(25.7) 5.949
501-1000 32(53.3) 22(36.7) 3
1001-1500 07(11.7) 10(16.7) 0.113
1501 and above 05(08.3) 13(21.7)
Religion 3.003
Hinduism 53(88.3) 58(96.7) 1
Others 07(11.7) 02(03.3) 0.083
Caste 3.333
General 09(15.0) 03(05.0) 1
SC 51(85.0) 57(95.0) 0.68

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mean ± SD of age in months: Experimental group 51.95±9.409, Control group 49.62±8.980

RANGE: Experimental group 36-70 months, Control group 36-69 months

**Mean± SD of per capita income in Rs: Experimental group 921.08±561.84, Control group 1146.98 ±723.48

Table 2: Pre and Post intervention no. of episodes of illness among children (N=120)

VARIABLE

 

 

Pre

EXPERIMENTAL

GROUP (n=60)

 

Post

X²

df,

n (%),

p

CONTROL GROUP

(n=60)

 

Pre                          Post

X²

df,

 

p

intervention

n (%)

intervention

n (%)

value intervention           intervention

n (%)                       n (%)

Value
Total no of illness(episodes)

1                  25(41.7)

07(11.7) 42.170 20(33.3)                 25(41.7) 8.160
2 or more         19(31.7) 02(03.3) 2 05(08.4)                 08(13.3) 2
No illness,        16(26.6), 51(85.0) 0.001 35(58.3)                 27(45.0) 0.085

 

 

 

 

 

 

 

 

 

 

 

 

Table 3: Frequency of common diseases before and after the intervention in experimental and control groups.                                                                          (N=120)


ILLNESS                 EXPERIMENTAL GROUP (n=60)                             CONTROL GROUP (n=60)

Pre intervention   Post intervention                       Pre intervention                        Post intervention n (%)                                     

Vomiting                  06(10.0)        1( 1.7)                              2(03.3)                                   1(01.7)

Fever                     11(18.3)             4( 6.7)                           3(05.0)                                     6(10.0)

Constipation             08(13.3)                   –                            3(05.0)                                   3(05.0)

Diarrhea/dysentery    04(06.7)                         –                                –                                       2(03.3)

Rhinitis                 11(18.3)                   –                              4(06.7)                                        5(08.3)

Cough                    13(21.7)                    –                              6(10.0)                                     5(08.3)

Skin pustules           09(15.0)                   –                            4(06.7)                                     2(03.3)

Burning micturition 03(05.0)                         –                         2(03.3)                                   3(05.0)

The odds ratio for factor (experimental/ control) is 0.144 that means the subjects in the control group were having 7 times higher odds to experience the various illnesses as discussed above than that of subjects in experimental group (Table 4).

ODDS RATIO               Value                              95% confidence interval limits Lower                                    Upper
Table 4: Odds ratio of episodes of illness during last 1 month (after the intervention) i both the group Odds Ratio illness episodes (experimental / control) 0.144                                      0.060                              0.345 The regular consumption of sugar salt drink by children did not have any effect on the anthropometric measurements (weight, height, nutritional status, body built) of children. There was positive effect on the parameters of clinical dehydration scale. The general appearance, tongue texture had been improved in the experimental group. Daily fluid intake was increased up to 800 ml in the 58% of experimental subjects (p value<0.001) where as in the control group the daily fluid intake of the subjects remained almost same before and during the intervention. (Table 5)

Table 5: Clinical dehydration scale and daily fluid intake of children in experimental and control groups (N=120)

 

Variable Experimental

Group(n=60) Pre              Post

x²

df p

 

 

Pre

Control Group  

 

Post

x²

df p

intervention intervention value intervention intervention Value
General appearance of child 5.175 4.675
Normal 49(81.7) 57(95.0) 1 54(90.0) 45(75.0) 1
Thirsty/restless/ 11(18.3) 03(05.0) 0.023 06(10.0) 15(25.0) 0.31
sleepy/irritable,
Tongue*
Moist 48(80.0) 59(98.3) 10.46 55(91.7) 49(81.7) 2.596
Sticky 11(18.3) 01(01.7) 1 05(08.3) 11(18.3) 1
Dry 01(01.7) 00(00.0) 0.005 00(00.0) 00(00.0) 0.107
Daily fluid intake of child (ml/day)
Till 500 12(20.0) 02(03.3) 27.902 11(18.4) 10(16.7) 2.749
600 18(30.0) 08(13.3) 3 29(48.3) 23(38.3) 3
700 20(33.3) 15(25.0) 0.000 13(21.7) 18(30.0) 0.601
800 and above 10(16.7) 35(58.3) 07(11.7) 09(15.0)

 

 

 

 

 

 

 

 

 

 

 

 

Urinalysis showed that daily consumption of home made sugar salt drink by the children in experiment group improved the specific gravity and Ph of urine. About half of subjects in experimental group had normal specific gravity (1.010-1.020) after the intervention (p value<0.001) . About 2/3rdof the experimental group subjects had normal Ph range (6.5-8.5) after intervention (p value=0.017) whereas in the control group there was no effect on specific gravity and Ph of urine before and during the intervention (p value=0.666) (Table 6).Table 6: Pre and Post intervention urinary assessment of children in both the groups

Variable         Experimental Group(n=60)           X²

Pre                               Post                 df

intervention               intervention p

Control Group(n=60)

Pre                          Post

intervention         intervention

df

p

n(%)                             n(%)                 value n(%)                       n(%) value
Colour of the urine                                       16,681 2.627
Amber           41(68.3)                 58(96.7)     1 47(78.3)             39(65.0) 1
Dark yellow     19(31.7)                 02(03.3)        00.001 13(21.7)             21(35.0) 0.105
Specific gravity of the urine                                23.008 0.186
1.010-1.020 04(06.7)                  27(45.0)        1 15(25.0)             13(21.7) 1
1.020-1.030 56(93.3)                  33(55.0)        00.001 45(75.0)             47(78.3) 0.666
Ph of urine                                                                 7.63 1.154
4.5-6.5        34(54.7)                 20(33.3)        1 54(90.0)             50(83.03) 1
6.5-8.5        26(43.3)                 40(66.7)        0.006 06(10.0)             10(16.7) 0.283

 

 

 

 

 

 

 

 

 

 

 

 

DISCUSSION AND CONCLUSION:Water and electrolyte consumption in the form of sugar salt drink helps in relieving the various childhood problems but there are very few evidences base to prove this. The present study highlighted the effectiveness of regular consumption of home made sugar salt drink on health status of children. In the present study about 85% of the subjects did not have even a single episode of any illness during the intervention in the experimental group whereas in the control group the adverse trend was there. The results of the present study are consistent with study done in Turkey which showed that regular daily intake of the sugar salt drink build up the immunity of body, prevents the child against the common illnesses and also shorten the illness span to <2 days. (16) Total number of cases of acute illnesses such as vomiting, fever, constipation, diarrhea/ dysentery, rhinitis, cough, skin pustules and burning micturition etc had been decreased after the regular 1 month consumption of home made sugar salt drink whereas in the control group there was no difference in the pre and post intervention period. Similar kind of results are also found in previous studies such as Guppy et al conducted a study in 2005 which showed that the consistent use of liquids/water with salt helps in relieving sore throat/common cold.(18) A study done by L Editor among the school going children revealed that the problems of constipation, burning micturition can be relieved with the regular intake of water and electrolytes in the form of Sugar Saltolution.(19-20) Above all in the present study it has been found that the subjects in the experimental group were at the lower risk to have any acute illness than that of control group. There was no effect on the anthropometric measurements of children. It could be due to short span of the study. The general appearance, tongue texture was improved in the experimental group subjects. This all is due to increased fluid intake which hydrates the body. The urine colour, Ph, specific gravity was improved. There are very few studies done in the past related to this but literature says that proper water intake improves hydration status and thus brings the urinary Ph and specific gravity within normal ranges.Thus the study results showed that the daily regular consumption of home made sugar salt drink is very effective in maintaining the good health status of a child. It meets some of the proportion of the daily water and electrolyte requirements, helps to relive the common childhood health problems. Hence it is recommended that regular consumption of home made sugar salt drink can be used in the field areas to improve the health status of children. Similar study can be replicated in different setting with larger sample size for longer duration to generalize the evidences.

REFERENCES:

 1.Hydration and Nyam news from Caribbean food and nutrition institute [online] 2007 June 1: 1-4. Available from: http://www.google.com/ food and nutrition.

2. As referenced in Water UK, Wise up on water! Kids run on water too! Available from: http:// www.water.org.uk/home/water-for- health/resources/wise-up-children- web//Accessed on Oct. 22, 2011

3.Drinking water and children [Online] 2008 July 17. Available from: http// synoresysten.in// accessed on Oct 22, 2011

4.Benjamin Dehydration [Online] 2009. Available from: http// www.medicinenet.com// dehydration. Accessed on Oct. 20, 2011

5.Domestic Water Quantity, Service, Level and Health, WHO/SDE/ WSH/03.02. Geneva: World Health Organization 2003. Available from: http: www.who.int/water_sanitation_health/ diseases/wsh0302 accessed on Oct. 20, 2011

6.Dutta Heatstroke [0nline] 2008; 18: 817-23. Available from : http://www.apiindia.org/medicine// accessed on Oct. 20, 2011

7.Dietary Reference Intakes for Water, Potassium, Sodium, Chloride and Institute of Medicine of the National Academies. Washington DC[online] 2004. Available from: http:// books.nap.edu/catalog// accessed on Nov. 2, 2011

8.Vincent How Much Water Should Children Drink Each Day? [Online] 2010. Available from: http:// ezinear ticles.com//Vincent-Brown accessed on Dec. 20, 2011

9.Singh KU, Prasad R, Kumar Management of diarrhea in practice. Indian Journal of Pediatrics 2002; 69(8): 87-88.

10.Ahmed The season of gastroenteritis. The Daily Etalaat Srinagar 2008; July 20: 33-34.

11.Fact Sheet from WHO, EURO/ 04/ 03 Copenhagen, On Health effects of Heat waves [online] 2003 Sep

12.Available from: http:// www.google.com accessed on Oct. 20, 2011

13.Williams Management of Acute Diarrheal Disease. The Journal of Pediatrics 1991; 118:S80-S85.

14.Home made ORS recipe [Online] Available from: http: // www.rehydrate.org// Accessed on Oct. 20, 2011

15.Dippennar H. Home made sugar salt solution for oral rehydration: knowledge of mothers and care givers. SA Family Practice [serial Online] 2005; 47(2). Available from: http:// safpj.co.za// accessed on Sep. 22, 2011 Touchette An analysis of home- cased oral rehydration therapy. Journal Social Science & Medicine 1994; 39: 425- 432.

16.Isabelle Home-based oral rehydration therapy in rural Zimbabwe. Transactions of the Royal Society of Tropical Medicine and Hygiene [serial Online]; 78(1): [about 3 p]. Available from :http://www.sciencedirect.com// accessed on Sep. 20, 2011

17.Duncan M, Magee Oral Rehydration Therapy. Success Stories UNICEF [online] 2009 Available from: http:/www.google.com/ accessed on Sep. 20, 2011

18. MPB, Mickan SM, Del MC, Thorning Advising patients to increase fluid intake for treating acute respiratory infections (review). Cochrane database of systematic review 2005. Available at http://www.thecochranelibrary.com/userfiles/ coch/file/CD004419.pdf Accessed on Oct. 26, 2011.

19.Editors Urinary Tract Infection [online] 2009. Available from :http:// www.wikimedia.com, accessed on Sep. 18, 2011

20.Robert SH. Heatstroke. Emedicine emergency  medicine  [online].  Available from:     http://   www.medscape.com accessed on 15, 2011

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