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Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17

Wiens, K.E. and Lindstedt, P.A. and Blacker, B.F. and Johnson, K.B. and Baumann, M.M. and Schaeffer, L.E. and Abbastabar, H. and Abd-Allah, F. and Abdelalim, A. and Abdollahpour, I. and Abegaz, K.H. and Abejie, A.N. and Abreu, L.G. and Abrigo, M.R.M. and Abualhasan, A. and Accrombessi, M.M.K. and Acharya, D. and Adabi, M. and Adamu, A.A. and Adebayo, O.M. and Adedoyin, R.A. and Adekanmbi, V. and Adetokunboh, O.O. and Adhena, B.M. and Afarideh, M. and Ahmad, S. and Ahmadi, K. and Ahmed, A.E. and Ahmed, M.B. and Ahmed, R. and Akalu, T.Y. and Alahdab, F. and Al-Aly, Z. and Alam, N. and Alam, S. and Alamene, G.M. and Alanzi, T.M. and Alcalde-Rabanal, J.E. and Ali, B.A. and Alijanzadeh, M. and Alipour, V. and Aljunid, S.M. and Almasi, A. and Almasi-Hashiani, A. and Al-Mekhlafi, H.M. and Altirkawi, K.A. and Alvis-Guzman, N. and Alvis-Zakzuk, N.J. and Amini, S. and Amit, A.M.L. and Andrei, C.L. and Anjomshoa, M. and Anoushiravani, A. and Ansari, F. and Antonio, C.A.T. and Antony, B. and Antriyandarti, E. and Arabloo, J. and Aref, H.M.A. and Aremu, O. and Armoon, B. and Arora, A. and Aryal, K.K. and Arzani, A. and Asadi-Aliabadi, M. and Atalay, H.T. and Athari, S.S. and Athari, S.M. and Atre, S.R. and Ausloos, M. and Awoke, N. and Ayala Quintanilla, B.P. and Ayano, G. and Ayanore, M.A. and Aynalem, Y.A. and Azari, S. and Azzopardi, P.S. and Babaee, E. and Babalola, T.K. and Badawi, A. and Bairwa, M. and Bakkannavar, S.M. and Balakrishnan, S. and Bali, A.G. and Banach, M. and Banoub, J.A.M. and Barac, A. and Bärnighausen, T.W. and Basaleem, H. and Basu, S. and Bay, V.D. and Bayati, M. and Baye, E. and Bedi, N. and Beheshti, M. and Behzadifar, M. and Behzadifar, M. and Bekele, B.B. and Belayneh, Y.M. and Bell, M.L. and Bennett, D.A. and Berbada, D.A. and Bernstein, R.S. and Bhat, A.G. and Bhattacharyya, K. and Bhattarai, S. and Bhaumik, S. and Bhutta, Z.A. and Bijani, A. and Bikbov, B. and Birihane, B.M. and Biswas, R.K. and Bohlouli, S. and Bojia, H.A. and Boufous, S. and Brady, O.J. and Bragazzi, N.L. and Briko, A.N. and Briko, N.I. and Britton, G.B. and Burugina Nagaraja, S. and Busse, R. and Butt, Z.A. and Cámera, L.A. and Campos-Nonato, I.R. and Cano, J. and Car, J. and Cárdenas, R. and Carvalho, F. and Castañeda-Orjuela, C.A. and Castro, F. and Chanie, W.F. and Chatterjee, P. and Chattu, V.K. and Chichiabellu, T.Y. and Chin, K.L. and Christopher, D.J. and Chu, D.-T. and Cormier, N.M. and Costa, V.M. and Culquichicon, C. and Daba, M.S. and Damiani, G. and Dandona, L. and Dandona, R. and Dang, A.K. and Darwesh, A.M. and Darwish, A.H. and Daryani, A. and Das, J.K. and Das Gupta, R.D. and Dash, A.P. and Davey, G. and Dávila-Cervantes, C.A. and Davis, A.C. and Davitoiu, D.V. and De la Hoz, F.P. and Demis, A.B. and Demissie, D.B. and Demissie, G.D. and Demoz, G.T. and Denova-Gutiérrez, E. and Deribe, K. and Desalew, A. and Deshpande, A. and Dharmaratne, S.D. and Dhillon, P. and Dhimal, M. and Dhungana, G.P. and Diaz, D. and Dipeolu, I.O. and 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Jayatilleke, A.U. and Jha, R.P. and Jha, V. and Ji, J.S. and Jonas, J.B. and Jozwiak, J.J. and Kabir, A. and Kabir, Z. and Kahsay, A. and Kalani, H. and Kanchan, T. and Karami Matin, B. and Karch, A. and Karim, M.A. and Karimi-Sari Surendra Karki, H. and Kasaeian, A. and Kasahun, G.G. and Kasahun, Y.C. and Kasaye, H.K. and Kassa, G.G. and Kassa, G.M. and Kayode, G.A. and Kazemi Karyani, A. and Kebede, M.M. and Keiyoro, P.N. and Kelbore, A.G. and Kengne, A.P. and Ketema, D.B. and Khader, Y.S. and Khafaie, M.A. and Khalid, N. and Khalilov, R. and Khan, E.A. and Khan, J. and Khan, M.N. and Khan, M.S. and Khatab, K. and Khater, A.M. and Khater, M.M. and Khayamzadeh, M. and Khazaei, M. and Khazaei, S. and Khosravi, M.H. and Khubchandani, J. and Kiadaliri, A. and Kim, Y.J. and Kimokoti, R.W. and Kisa, A. and Kisa, S. and Kissoon, N. and Shivakumar, K.M. and Kochhar, S. and Kolola, T. and Komaki, H. and Kosen, S. and Koul, P.A. and Koyanagi, A. and Kraemer, M.U.G. and Krishan, K. and Kugbey, N. and Kumar, G.A. and Kumar, M. and Kumar, P. and Kumar, V. and Kusuma, D. and La Vecchia, C. and Lacey, B. and Lad, S.D. and Lal, D.K. and Lam, F. and Lami, F.H. and Lamichhane, P. and Lansingh, V.C. and Lasrado, S. and Laxmaiah, A. and Lee, P.H. and LeGrand, K.E. and Leili, M. and Lenjebo, T.L. and Leshargie, C.T. and Levine, A.J. and Li, S. and Linn, S. and Liu, S. and Liu, S. and Lodha, R. and Longbottom, J. and Lopez, J.C.F. and Magdy Abd El Razek, H. and Magdy Abd El Razek, M. and Mahadeshwara Prasad, DR. and Mahasha, P.W. and Mahotra, N.B. and Majeed, A. and Malekzadeh, R. and Malta, D.C. and Mamun, A.A. and Manafi, N. and Manda, A.L. and Manohar, N.D.D. and Mansournia, M.A. and Mapoma, C.C. and Maravilla, J.C. and Martinez, G. and Martini, S. and Martins-Melo, F.R. and Masaka, A. and Massenburg, B.B. and Mathur, M.R. and Mayala, B.K. and Mazidi, M. and McAlinden, C. and Meharie, B.G. and Mehndiratta, M.M. and Mehta, K.M. and Mekonnen, T.C. and Meles, G.G. and Memiah, P.T.N. and Memish, Z.A. and Mendoza, W. and Menezes, R.G. and Mereta, S.T. and Meretoja, T.J. and Mestrovic, T. and Miazgowski, B. and Mihretie, K.M. and Miller, T.R. and Mini, G.K. and Mirrakhimov, E.M. and Moazen, B. and Mohajer, B. and Mohamadi-Bolbanabad, A. and Mohammad, D.K. and Mohammad, K.A. and Mohammad, Y. and Mohammad Gholi Mezerji, N. and Mohammadibakhsh, R. and Mohammadifard, N. and Mohammed, J.A. and Mohammed, S. and Mohebi, F. and Mokdad, A.H. and Molokhia, M. and Monasta, L. and Moodley, Y. and Moore, C.E. and Moradi, G. and Moradi, M. and Moradi-Joo, M. and Moradi-Lakeh, M. and Moraga, P. and Morales, L. and Moreno Velásquez, I. and Mosapour, A. and Mouodi, S. and Mousavi, S.M. and Mozaffor, M. and Muchie, K.F. and Mulaw, G.F. and Munro, S.B. and Muriithi, M.K. and Murray, C.J. and Murthy, G.V.S. and Musa, K.I. and Mustafa, G. and Muthupandian, S. and Nabhan, A.F. and Naderi, M. and Nagarajan, A.J. and Naidoo, K.S. and Naik, G. and Najafi, F. and Nangia, V. and Nansseu, J.R. 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Yu, C. and Yusefzadeh, H. and Zadey, S. and Zaidi, Z. and Zaman, S.B. and Zamani, M. and Zandian, H. and Zepro, N.B. and Zerfu, T.A. and Zhang, Y. and Zhao, X.-J.G. and Ziapour, A. and Zodpey, S. and Zuniga, Y.M.H. and Hay, S.I. and Reiner, Jr. (2020) Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17. The Lancet Global Health, 8 (8). e1038-e1060.

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Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000�17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50 in the majority (62·6; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95 UI 5 254 000�7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50 difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910�68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Item Type: Article
Additional Information: cited By 3
Uncontrolled Keywords: electrolyte solution; oral rehydration solution, adolescent; adult; Article; child; Colombia; diarrhea; female; geographic mapping; human; low income country; male; middle income country; mortality; mortality rate; Nigeria; oral rehydration therapy; preschool child; priority journal; risk factor; scale up; Sudan; Bayes theorem; developing country; diarrhea; fluid therapy; geography; health care disparity; health care survey; infant; newborn; statistical model, Bayes Theorem; Child, Preschool; Developing Countries; Diarrhea; Fluid Therapy; Geography; Health Care Surveys; Healthcare Disparities; Humans; Infant; Infant, Newborn; Models, Statistical
Subjects: دندانپزشکی ، جراحی دهان WU
بهداشت عمومی WA
مقالات نمایه شده محققین دانشگاه در سایت ,Web of Science ,Scopus
Divisions: معاونت تحقیقات و فناوری
Depositing User: GOUMS
Date Deposited: 05 Jan 2021 11:07
Last Modified: 05 Jan 2021 11:07
URI: http://eprints.goums.ac.ir/id/eprint/10888

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