TY - JOUR
T1 - Oral rehydration therapies in Senegal, Mali, and Sierra Leone
T2 - a spatial analysis of changes over time and implications for policy
AU - Wiens, Kirsten E.
AU - Schaeffer, Lauren E.
AU - Sow, Samba O.
AU - Ndoye, Babacar
AU - Cain, Carrie Jo
AU - Baumann, Mathew M.
AU - Johnson, Kimberly B.
AU - Lindstedt, Paulina A.
AU - Blacker, Brigette F.
AU - Bhutta, Zulfiqar A.
AU - Cormier, Natalie M.
AU - Daoud, Farah
AU - Earl, Lucas
AU - Farag, Tamer
AU - Khalil, Ibrahim A.
AU - Kinyoki, Damaris K.
AU - Larson, Heidi J.
AU - LeGrand, Kate E.
AU - Cook, Aubrey J.
AU - Malta, Deborah C.
AU - Månsson, Johan C.
AU - Mayala, Benjamin K.
AU - Mokdad, Ali H.
AU - Ogbuanu, Ikechukwu U.
AU - Sankoh, Osman
AU - Sartorius, Benn
AU - Topor-Madry, Roman
AU - Troeger, Christopher E.
AU - Welgan, Catherine A.
AU - Werdecker, Andrea
AU - Hay, Simon I.
AU - Reiner, Robert C.
N1 - Publisher Copyright:
© 2020, The Author(s).
PY - 2020/12
Y1 - 2020/12
N2 - Background: Oral rehydration solution (ORS) is a simple intervention that can prevent childhood deaths from severe diarrhea and dehydration. In a previous study, we mapped the use of ORS treatment subnationally and found that ORS coverage increased over time, while the use of home-made alternatives or recommended home fluids (RHF) decreased, in many countries. These patterns were particularly striking within Senegal, Mali, and Sierra Leone. It was unclear, however, whether ORS replaced RHF in these locations or if children were left untreated, and if these patterns were associated with health policy changes. Methods: We used a Bayesian geostatistical model and data from household surveys to map the percentage of children with diarrhea that received (1) any ORS, (2) only RHF, or (3) no oral rehydration treatment between 2000 and 2018. This approach allowed examination of whether RHF was replaced with ORS before and after interventions, policies, and external events that may have impacted healthcare access. Results: We found that RHF was replaced with ORS in most Sierra Leone districts, except those most impacted by the Ebola outbreak. In addition, RHF was replaced in northern but not in southern Mali, and RHF was not replaced anywhere in Senegal. In Senegal, there was no statistical evidence that a national policy promoting ORS use was associated with increases in coverage. In Sierra Leone, ORS coverage increased following a national policy change that abolished health costs for children. Conclusions: Children in parts of Mali and Senegal have been left behind during ORS scale-up. Improved messaging on effective diarrhea treatment and/or increased ORS access such as through reducing treatment costs may be needed to prevent child deaths in these areas.
AB - Background: Oral rehydration solution (ORS) is a simple intervention that can prevent childhood deaths from severe diarrhea and dehydration. In a previous study, we mapped the use of ORS treatment subnationally and found that ORS coverage increased over time, while the use of home-made alternatives or recommended home fluids (RHF) decreased, in many countries. These patterns were particularly striking within Senegal, Mali, and Sierra Leone. It was unclear, however, whether ORS replaced RHF in these locations or if children were left untreated, and if these patterns were associated with health policy changes. Methods: We used a Bayesian geostatistical model and data from household surveys to map the percentage of children with diarrhea that received (1) any ORS, (2) only RHF, or (3) no oral rehydration treatment between 2000 and 2018. This approach allowed examination of whether RHF was replaced with ORS before and after interventions, policies, and external events that may have impacted healthcare access. Results: We found that RHF was replaced with ORS in most Sierra Leone districts, except those most impacted by the Ebola outbreak. In addition, RHF was replaced in northern but not in southern Mali, and RHF was not replaced anywhere in Senegal. In Senegal, there was no statistical evidence that a national policy promoting ORS use was associated with increases in coverage. In Sierra Leone, ORS coverage increased following a national policy change that abolished health costs for children. Conclusions: Children in parts of Mali and Senegal have been left behind during ORS scale-up. Improved messaging on effective diarrhea treatment and/or increased ORS access such as through reducing treatment costs may be needed to prevent child deaths in these areas.
KW - Diarrhea
KW - Geospatial modeling
KW - Health policies
KW - Oral rehydration solution
KW - Oral rehydration therapy
KW - Recommended home fluids
KW - Spatial analysis
UR - http://www.scopus.com/inward/record.url?scp=85097845945&partnerID=8YFLogxK
U2 - 10.1186/s12916-020-01857-7
DO - 10.1186/s12916-020-01857-7
M3 - Article
C2 - 33342436
AN - SCOPUS:85097845945
SN - 1741-7015
VL - 18
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 405
ER -