August 30, 2020 Journal article Open Access

Local Burden of Disease Diarrhoea Collaborators*

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  <identifier identifierType="URL">https://nadre.ethernet.edu.et/record/8661</identifier>
  <creators>
    <creator>
      <creatorName>Local Burden of Disease Diarrhoea Collaborators*</creatorName>
    </creator>
  </creators>
  <titles>
    <title>Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17</title>
  </titles>
  <publisher>Zenodo</publisher>
  <publicationYear>2020</publicationYear>
  <dates>
    <date dateType="Issued">2020-08-30</date>
  </dates>
  <resourceType resourceTypeGeneral="JournalArticle"/>
  <alternateIdentifiers>
    <alternateIdentifier alternateIdentifierType="url">https://nadre.ethernet.edu.et/record/8661</alternateIdentifier>
  </alternateIdentifiers>
  <relatedIdentifiers>
    <relatedIdentifier relatedIdentifierType="DOI" relationType="IsIdenticalTo">10.1016/S2214-109X(20)30230-8</relatedIdentifier>
  </relatedIdentifiers>
  <rightsList>
    <rights rightsURI="https://creativecommons.org/licenses/by-nc/4.0/">Creative Commons Attribution-NonCommercial</rights>
    <rights rightsURI="info:eu-repo/semantics/openAccess">Open Access</rights>
  </rightsList>
  <descriptions>
    <description descriptionType="Abstract">&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;&lt;/p&gt;

&lt;p&gt;Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the&lt;br&gt;
potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger&lt;br&gt;
than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of&lt;br&gt;
recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent&lt;br&gt;
child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but&lt;br&gt;
subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and&lt;br&gt;
absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs.&lt;br&gt;
&lt;strong&gt;Methods &lt;/strong&gt;&lt;/p&gt;

&lt;p&gt;We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys&lt;br&gt;
across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received&lt;br&gt;
ORS or RHF (or both) on continuous continent-wide surfaces in 2000&amp;ndash;17, and aggregated results to policy-relevant&lt;br&gt;
administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and&lt;br&gt;
estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the&lt;br&gt;
mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and&lt;br&gt;
creating uncertainty intervals (UIs) with the 2&amp;middot;5th and 97&amp;middot;5th percentiles of those 250 draws.&lt;br&gt;
&lt;strong&gt;Findings&lt;/strong&gt;&lt;/p&gt;

&lt;p&gt;While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage&lt;br&gt;
remained below 50% in the majority (62&amp;middot;6%; 12 417 of 19 823) of second administrative-level units and an estimated&lt;br&gt;
6 519 000 children (95% UI 5 254 000&amp;ndash;7 733 000) with diarrhoea were not treated with any form of ORT in 2017.&lt;br&gt;
Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall&lt;br&gt;
ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, withincountry&lt;br&gt;
geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units&lt;br&gt;
compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in&lt;br&gt;
diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910&amp;ndash;68 860) were averted by&lt;br&gt;
scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria,&lt;br&gt;
and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains&lt;br&gt;
lower than average.&lt;br&gt;
&lt;strong&gt;Interpretation&lt;/strong&gt;&lt;/p&gt;

&lt;p&gt;To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and&lt;br&gt;
ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress&lt;br&gt;
over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can&lt;br&gt;
support subnational needs assessments aimed at furthering policy makers&amp;rsquo; understanding of within-country&lt;br&gt;
disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in&lt;br&gt;
reducing mortality could still be made by reducing geographical inequalities in ORS coverage.&lt;/p&gt;</description>
  </descriptions>
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