August 30, 2020 Journal article Open Access

Local Burden of Disease Diarrhoea Collaborators*

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{
  "DOI": "10.1016/S2214-109X(20)30230-8", 
  "author": [
    {
      "family": "Local Burden of Disease Diarrhoea Collaborators*"
    }
  ], 
  "issued": {
    "date-parts": [
      [
        2020, 
        8, 
        30
      ]
    ]
  }, 
  "abstract": "<p><strong>Background</strong></p>\n\n<p>Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the<br>\npotential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger<br>\nthan 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of<br>\nrecommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent<br>\nchild mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but<br>\nsubnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and<br>\nabsolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs.<br>\n<strong>Methods </strong></p>\n\n<p>We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys<br>\nacross 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received<br>\nORS or RHF (or both) on continuous continent-wide surfaces in 2000&ndash;17, and aggregated results to policy-relevant<br>\nadministrative units. Additionally, we analysed geographical inequality in coverage across administrative units and<br>\nestimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the<br>\nmean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and<br>\ncreating uncertainty intervals (UIs) with the 2&middot;5th and 97&middot;5th percentiles of those 250 draws.<br>\n<strong>Findings</strong></p>\n\n<p>While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage<br>\nremained below 50% in the majority (62&middot;6%; 12 417 of 19 823) of second administrative-level units and an estimated<br>\n6 519 000 children (95% UI 5 254 000&ndash;7 733 000) with diarrhoea were not treated with any form of ORT in 2017.<br>\nIncreases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall<br>\nORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, withincountry<br>\ngeographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units<br>\ncompared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in<br>\ndiarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910&ndash;68 860) were averted by<br>\nscaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria,<br>\nand Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains<br>\nlower than average.<br>\n<strong>Interpretation</strong></p>\n\n<p>To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and<br>\nORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress<br>\nover time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can<br>\nsupport subnational needs assessments aimed at furthering policy makers&rsquo; understanding of within-country<br>\ndisparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in<br>\nreducing mortality could still be made by reducing geographical inequalities in ORS coverage.</p>", 
  "title": "Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000\u201317", 
  "type": "article-journal", 
  "id": "8661"
}