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

Kirsten E. Wiens, Paulina A. Lindstedt, Brigette F. Blacker, Kimberly B. Johnson, Mathew M. Baumann, Lauren E. Schaeffer, Hedayat Abbastabar, Foad Abd-Allah, Ahmed Abdelalim, Ibrahim Abdollahpour, Kedir Hussein Abegaz, Ayenew Negesse Abejie, Lucas Guimarães Abreu, Michael R.M. Abrigo, Ahmed Abualhasan, Manfred Mario Kokou Accrombessi, Dilaram Acharya, Maryam Adabi, Abdu A. Adamu, Oladimeji M. AdebayoRufus Adesoji Adedoyin, Victor Adekanmbi, Olatunji O. Adetokunboh, Beyene Meressa Adhena, Mohsen Afarideh, Sohail Ahmad, Keivan Ahmadi, Anwar E. Ahmed, Muktar Beshir Ahmed, Rushdia Ahmed, Temesgen Yihunie Akalu, Fares Alahdab, Ziyad Al-Aly, Noore Alam, Samiah Alam, Genet Melak Alamene, Turki M. Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Beriwan Abdulqadir Ali, Mehran Alijanzadeh, Vahid Alipour, Syed Mohamed Aljunid, Ali Almasi, Amir Almasi-Hashiani, Hesham M. Al-Mekhlafi, Khalid A. Altirkawi, Nelson Alvis-Guzman, Nelson J. Alvis-Zakzuk, Saeed Amini, Arianna Maever L. Amit, Catalina Liliana Andrei, Mina Anjomshoa, Amir Anoushiravani, Fereshteh Ansari, Carl Abelardo T. Antonio, Benny Antony, Ernoiz Antriyandarti, Jalal Arabloo, Hany Mohamed Amin Aref, Olatunde Aremu, Bahram Armoon, Amit Arora, Krishna K. Aryal, Afsaneh Arzani, Mehran Asadi-Aliabadi, Hagos Tasew Atalay, Seyyed Shamsadin Athari, Seyyede Masoume Athari, Sachin R. Atre, Marcel Ausloos, Nefsu Awoke, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Yared Asmare Aynalem IV, Samad Azari, Peter S. Azzopardi, Ebrahim Babaee, Tesleem Kayode Babalola, Alaa Badawi, Mohan Bairwa, Shankar M. Bakkannavar, Senthilkumar Balakrishnan, Ayele Geleto Bali, Maciej Banach, Joseph Adel Mattar Banoub, Aleksandra Barac, Till Winfried Bärnighausen, Huda Basaleem, Sanjay Basu, Vo Dinh Bay, Mohsen Bayati, Estifanos Baye, Neeraj Bedi, Mahya Mahya Beheshti Beheshti, Masoud Behzadifar, Meysam Behzadifar, Bayu Begashaw Bekele, Yaschilal Muche Belayneh, Michellr L. Bell, Derrick A. Bennett, Dessalegn Ajema Berbada, Robert S. Bernstein, Anusha Ganapati Bhat, Krittika Bhattacharyya, Suraj Bhattarai, Soumyadeep Bhaumik, Zulfiqar A. Bhutta, Ali Bijani, Boris Bikbov, Binyam Minuye Birihane IV, Raaj Kishore Biswas, Somayeh Bohlouli, Hunduma Amensisa Amensisa Bojia I, Soufiane Boufous, Oliver J. Brady, Nicola Luigi Bragazzi, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Gabrielle B. Britton, Sharath Burugina Nagaraja, Reinhard Busse, Zahid A. Butt, Luis LA Alberto Cámera, Ismael R. Campos-Nonato, Jorge Cano, Josip Car, Rosario Cárdenas, Felix Carvalho, Carlos A. Castañeda-Orjuela, Franz Castro, Wagaye Fentahun Chanie, Pranab Chatterjee, Vijay Kumar Chattu, Tesfaye Yitna Yitna Chichiabellu, Ken Lee Chin, Devasahayam J. Christopher, Dinh Toi Chu, Natalie Maria Cormier, Vera Marisa Costa, Carlos Culquichicon, Matiwos Soboka Daba, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Anh Kim Dang, Aso Mohammad Darwesh, Amira Hamed Darwish, Ahmad Daryani, Jai K. Das, Rajat Das Gupta, Aditya Prasad Dash, Gail Davey, Claudio Alberto Dávila-Cervantes, Adrian C. Davis, Dragos Virgil Davitoiu, Fernando Pio De la Hoz, Asmamaw Bizuneh Demis, Dereje Bayissa Demissie, Getu Debalkie Demissie, Gebre Teklemariam Demoz, Edgar Denova-Gutiérrez, Kebede Deribe, Assefa Desalew, Aniruddha Deshpande, Samath Dhamminda Dharmaratne, Preeti Dhillon, Meghnath Dhimal, Govinda Prasad Dhungana, Daniel Diaz, Isaac Oluwafemi Dipeolu, Shirin Djalalinia, Kerrie E. Doyle, Eleonora Dubljanin, Bereket Duko, Andre Rodrigues Duraes, Mohammad Ebrahimi Kalan, Hisham Atan Edinur, Andem Effiong, Aziz Eftekhari, Nevine El Nahas, Iman El Sayed, Maysaa El Sayed Zaki, Maha El Tantawi, Teshome Bekele Elema I, Hala Rashad Elhabashy, Shaimaa I. El-Jaafary, Hajer Elkout, Aisha Elsharkawy, Iqbal RF Elyazar, Aklilu Endalamaw, Daniel Adane Endalew, Sharareh Eskandarieh, Alireza Esteghamati, Sadaf Esteghamati, Arash Etemadi, Oluchi Ezekannagha, Mohammad Fareed, Roghiyeh Faridnia, Farshad Farzadfar, Mehdi Fazlzadeh, Valery L. Feigin, Seyed Mohammad Fereshtehnejad, Eduarda Fernandes, Irina Filip, Florian Fischer, Nataliya A. Foigt, Morenike Oluwatoyin Folayan, Masoud Foroutan, Richard Charles Franklin, Takeshi Fukumoto, Mohamed M. Gad, Reta Tsegaye Gayesa, Teshome Gebre, Ketema Bizuwork Gebremedhin, Gebreamlak Gebremedhn Gebremeskel, Hailay Abrha Gesesew, Kebede Embaye Gezae, Keyghobad Ghadiri, Ahmad Ghashghaee, Pramesh Raj Ghimire, Paramjit Singh Gill, Tiffany K. Gill, Themba G.G. Ginindza, Nelson G.M. Gomes, Sameer Vali Gopalani, Alessandra C. Goulart, Bárbara Niegia Garcia Goulart, Ayman Grada, Mohammed Ibrahim Mohialdeen Gubari, Harish Chander Gugnani, Davide Guido, Rafael Alves Guimarães, Yuming Guo, Rajeev Gupta, Nima Hafezi-Nejad, Dessalegn H. Haile, Gessessew Bugssa Hailu, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Randah R. Hamadeh, Samer Hamidi, Demelash Woldeyohannes Handiso, Hamidreza Haririan, Ninuk Hariyani, Ahmed I. Hasaballah, Md Mehedi Hasan, Edris Hasanpoor, Amir Hasanzadeh, Hadi Hassankhani, Hamid Yimam Hassen, Mohamed I. Hegazy, Behzad Heibati, Behnam Heidari, Delia Hendrie, Nathaniel J. Henry, Claudiu Herteliu, Fatemeh Heydarpour, Hagos Degefa de Hidru I, Thomas R. Hird, Chi Linh Hoang, Enayatollah Homaie Rad, Praveen Hoogar, Mohammad Hoseini, Naznin Hossain, Mostafa Hosseini, Mehdi Hosseinzadeh, Mowafa Househ, Mohamed Hsairi, Guoqing Hu, Mohammedaman Mama Hussen, Segun Emmanuel Ibitoye, Ehimario U. Igumbor, Olayinka Stephen Ilesanmi, Milena D. 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Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)e1038-e1060
JournalThe Lancet Global Health
Volume8
Issue number8
DOIs
Publication statusPublished - Aug 2020

ASJC Scopus subject areas

  • Medicine(all)

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