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 Guimaraes Abreu; Michael R. M. Abrigo; Ahmed Abualhasan; Manfred Mario Kokou Accrombessi; Dilaram Acharya; Maryam Adabi; Abdu A. Adamu; Oladimeji M. Adebayo; Rufus 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; 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 Barnighausen; Huda Basaleem; Sanjay Basu; Vo Dinh Bay; Mohsen Bayati; Estifanos Baye; Neeraj Bedi; Mahya Beheshti; Masoud Behzadifar; Meysam Behzadifar; Bayu Begashaw Bekele; Yaschilal Muche Belayneh; Michelle L. Bell; Local Burden of Disease Diarrhoea Collaborators; David C Schwebel

doi:10.1016/S2214-109X(20)30230-8

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

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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, …

The Lancet global health, Vol.8(8), pp.1038-1060

08/01/2020

DOI: 10.1016/S2214-109X(20)30230-8

PMCID: PMC7388204

PMID: 32710861

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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 center dot 5th and 97 center dot 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 center dot 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. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

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Title: Subtitle: Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17
Creators: Kirsten E. Wiens - University of Washington
Paulina A. Lindstedt - University of Washington
Brigette F. Blacker - University of Washington
Kimberly B. Johnson - Institute for Health Metrics and Evaluation
Mathew M. Baumann - Institute for Health Metrics and Evaluation
Lauren E. Schaeffer - University of Washington
Hedayat Abbastabar - Institute for Health Metrics and Evaluation
Foad Abd-Allah - Institute for Health Metrics and Evaluation
Ahmed Abdelalim - Institute for Health Metrics and Evaluation
Ibrahim Abdollahpour - Institute for Health Metrics and Evaluation
Kedir Hussein Abegaz - Institute for Health Metrics and Evaluation
Ayenew Negesse Abejie - Institute for Health Metrics and Evaluation
Lucas Guimaraes Abreu - Institute for Health Metrics and Evaluation
Michael R. M. Abrigo - Institute for Health Metrics and Evaluation
Ahmed Abualhasan - Institute for Health Metrics and Evaluation
Manfred Mario Kokou Accrombessi - London Sch Hyg & Trop Med, Dept Dis Control, London, England
Dilaram Acharya - Institute for Health Metrics and Evaluation
Maryam Adabi - Institute for Health Metrics and Evaluation
Abdu A. Adamu - Institute for Health Metrics and Evaluation
Oladimeji M. Adebayo - Institute for Health Metrics and Evaluation
Rufus Adesoji Adedoyin - Institute for Health Metrics and Evaluation
Victor Adekanmbi - University of Washington
Olatunji O. Adetokunboh - Institute for Health Metrics and Evaluation
Beyene Meressa Adhena - Institute for Health Metrics and Evaluation
Mohsen Afarideh - Institute for Health Metrics and Evaluation
Sohail Ahmad - Institute for Health Metrics and Evaluation
Keivan Ahmadi - University of Washington
Anwar E. Ahmed - Institute for Health Metrics and Evaluation
Muktar Beshir Ahmed - Institute for Health Metrics and Evaluation
Rushdia Ahmed - Institute for Health Metrics and Evaluation
Temesgen Yihunie Akalu - Institute for Health Metrics and Evaluation
Fares Alahdab - Institute for Health Metrics and Evaluation
Ziyad Al-Aly - Institute for Health Metrics and Evaluation
Noore Alam - Institute for Health Metrics and Evaluation
Samiah Alam - Dalhousie University
Genet Melak Alamene - Institute for Health Metrics and Evaluation
Turki M. Alanzi - Institute for Health Metrics and Evaluation
Jacqueline Elizabeth Alcalde-Rabanal - Institute for Health Metrics and Evaluation
Beriwan Abdulqadir Ali - Institute for Health Metrics and Evaluation
Mehran Alijanzadeh - Institute for Health Metrics and Evaluation
Vahid Alipour - University of Washington
Syed Mohamed Aljunid - Institute for Health Metrics and Evaluation
Ali Almasi - Institute for Health Metrics and Evaluation
Amir Almasi-Hashiani - Institute for Health Metrics and Evaluation
Hesham M. Al-Mekhlafi - University of Washington
Khalid A. Altirkawi - Institute for Health Metrics and Evaluation
Nelson Alvis-Guzman - Institute for Health Metrics and Evaluation
Nelson J. Alvis-Zakzuk - Institute for Health Metrics and Evaluation
Saeed Amini - Arak University
Arianna Maever L. Amit - Institute for Health Metrics and Evaluation
Catalina Liliana Andrei - Institute for Health Metrics and Evaluation
Mina Anjomshoa - Institute for Health Metrics and Evaluation
Amir Anoushiravani - University of Washington
Fereshteh Ansari - Institute for Health Metrics and Evaluation
Carl Abelardo T. Antonio - University of Washington
Benny Antony - Institute for Health Metrics and Evaluation
Ernoiz Antriyandarti - Institute for Health Metrics and Evaluation
Jalal Arabloo - Institute for Health Metrics and Evaluation
Hany Mohamed Amin Aref - Ain Shams University
Olatunde Aremu - Institute for Health Metrics and Evaluation
Bahram Armoon - Institute for Health Metrics and Evaluation
Amit Arora - Institute for Health Metrics and Evaluation
Krishna K. Aryal - Schulman, Ronca & Bucuvalas
Afsaneh Arzani - Institute for Health Metrics and Evaluation
Mehran Asadi-Aliabadi - Institute for Health Metrics and Evaluation
Hagos Tasew Atalay - University of Washington
Seyyed Shamsadin Athari - Institute for Health Metrics and Evaluation
Seyyede Masoume Athari - Institute for Health Metrics and Evaluation
Sachin R. Atre - University of Washington
Marcel Ausloos - Institute for Health Metrics and Evaluation
Nefsu Awoke - Institute for Health Metrics and Evaluation
Beatriz Paulina Ayala Quintanilla - Institute for Health Metrics and Evaluation
Getinet Ayano - Institute for Health Metrics and Evaluation
Martin Amogre Ayanore - Institute for Health Metrics and Evaluation
Yared Asmare Aynalem - Debre Berhan University
Samad Azari - Institute for Health Metrics and Evaluation
Peter S. Azzopardi - Institute for Health Metrics and Evaluation
Ebrahim Babaee - Institute for Health Metrics and Evaluation
Tesleem Kayode Babalola - University of Washington
Alaa Badawi - Institute for Health Metrics and Evaluation
Mohan Bairwa - Institute for Health Metrics and Evaluation
Shankar M. Bakkannavar - Institute for Health Metrics and Evaluation
Senthilkumar Balakrishnan - University of Washington
Ayele Geleto Bali - Haramaya University
Maciej Banach - University of Washington
Joseph Adel Mattar Banoub - Institute for Health Metrics and Evaluation
Aleksandra Barac - Institute for Health Metrics and Evaluation
Till Winfried Barnighausen - Institute for Health Metrics and Evaluation
Huda Basaleem - Institute for Health Metrics and Evaluation
Sanjay Basu - Institute for Health Metrics and Evaluation
Vo Dinh Bay - Institute for Health Metrics and Evaluation
Mohsen Bayati - Institute for Health Metrics and Evaluation
Estifanos Baye - Institute for Health Metrics and Evaluation
Neeraj Bedi - Institute for Health Metrics and Evaluation
Mahya Beheshti - NYU, Dept Phys Med & Rehabil, New York, NY USA
Masoud Behzadifar - University of Washington
Meysam Behzadifar - Institute for Health Metrics and Evaluation
Bayu Begashaw Bekele - Institute for Health Metrics and Evaluation
Yaschilal Muche Belayneh - Institute for Health Metrics and Evaluation
Michelle L. Bell - Yale University
Local Burden of Disease Diarrhoea Collaborators
David C Schwebel (Contributor) - Research Administration
Resource Type: Journal article
Publication Details: The Lancet global health, Vol.8(8), pp.1038-1060
DOI: 10.1016/S2214-109X(20)30230-8
PMID: 32710861
PMCID: PMC7388204
NLM abbreviation: Lancet Glob Health
ISSN: 2214-109X
eISSN: 2214-109X
Publisher: Elsevier
Number of pages: 23
Grant note: 001 / Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior; Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES) Wellcome Trust 201900/Z/16/Z / Wellcome Trust as part of his International Intermediate Fellowship; Wellcome Trust P01-AG041710 / National Institute on Aging of NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) Sistema Nacional de Investigacion (SENACYT, Panama) OI175014 / Ministry of Education Science and Technological Development of the Republic of Serbia; Ministry of Education, Science & Technological Development, Serbia 175087 / Ministry of Education, Science and Technological Development of the Republic of Serbia; Ministry of Education, Science & Technological Development, Serbia NIHR Biomedical Research Center at Guy's and St Thomas' National Health Service Foundation Trust and King's College London OPP1132415; OPP1127433 / Bill AMP; Melinda Gates Foundation; CGIAR Australian National Health and Medical Research Council (NHMRC) early career fellowship; National Health & Medical Research Council (NHMRC) of Australia
Language: English
Date published: 08/01/2020
Academic Unit: Research Administration
Record Identifier: 9984949183302771

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