Declining impact of oral rehydration therapy in a Papua New Guinea Highlands Province: a case study with implications for Papua New Guinea's National Diarrheal Disease Control Program.

A provincial diarrheal disease control program that was based on the delivery of oral rehydration solution (ORS) from health facilities now places greater emphasis on the management of diarrhea with fluids at home. The change in strategy has been associated with decreasing utilization of health facilities and increasing mortality from diarrheal disease. The declining impact is attributed to the promotion of home-based management with little preparation of the target population for their therapeutic role. National policy recommends home-based management for mild cases of diarrhea and ORS for more severe cases. Our observations in the Southern Highlands Province have important implications for the diarrheal disease control program in Papua New Guinea.