1. Oral rehydration therapies in Senegal, Mali, and Sierra Leone: a spatial analysis of changes over time and implications for policy
- Author
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Johan C. Månsson, Heidi J. Larson, Ibrahim A Khalil, Robert C. Reiner, Roman Topor-Madry, Farah Daoud, Ikechukwu U. Ogbuanu, Damaris K. Kinyoki, Samba O. Sow, Mathew M. Baumann, Kate E. LeGrand, Simon I. Hay, Deborah Carvalho Malta, Kimberly B. Johnson, Benn Sartorius, Brigette F. Blacker, Osman Sankoh, Natalie Maria Cormier, Christopher Troeger, Benjamin K. Mayala, Tamer H. Farag, Zulfiqar A Bhutta, Aubrey J. Cook, Babacar Ndoye, Lauren E. Schaeffer, Kirsten E. Wiens, Ali H. Mokdad, Catherine A. Welgan, Carrie Jo Cain, Paulina A. Lindstedt, Lucas Earl, and Andrea Werdecker
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,Psychological intervention ,lcsh:Medicine ,Administration, Oral ,Sodium Chloride ,Mali ,Severity of Illness Index ,Potassium Chloride ,0302 clinical medicine ,Health care ,Medicine ,030212 general & internal medicine ,Child ,Health Policy ,General Medicine ,Senegal ,Oral rehydration solution ,Diarrhea ,Treatment Outcome ,Child, Preschool ,Child Mortality ,Female ,medicine.symptom ,Statistical evidence ,Research Article ,030231 tropical medicine ,Oral rehydration therapy ,History, 21st Century ,Sierra leone ,Sierra Leone ,Health policies ,03 medical and health sciences ,Geospatial modeling ,Environmental health ,Humans ,Health policy ,Spatial Analysis ,business.industry ,lcsh:R ,Outbreak ,Infant ,History, 20th Century ,Bicarbonates ,Glucose ,Recommended home fluids ,Fluid Therapy ,business - Abstract
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.
- Published
- 2020