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Oral rehydration therapies in Senegal, Mali, and Sierra Leone: a spatial analysis of changes over time and implications for policy.
- Source :
-
BMC medicine [BMC Med] 2020 Dec 21; Vol. 18 (1), pp. 405. Date of Electronic Publication: 2020 Dec 21. - Publication Year :
- 2020
-
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.<br />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.<br />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.<br />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.
- Subjects :
- Administration, Oral
Bicarbonates therapeutic use
Child
Child Mortality history
Child Mortality trends
Child, Preschool
Diarrhea epidemiology
Female
Glucose therapeutic use
Health Policy history
History, 20th Century
History, 21st Century
Humans
Infant
Male
Mali epidemiology
Potassium Chloride therapeutic use
Senegal epidemiology
Severity of Illness Index
Sierra Leone epidemiology
Sodium Chloride therapeutic use
Spatial Analysis
Time Factors
Treatment Outcome
Diarrhea therapy
Fluid Therapy history
Fluid Therapy methods
Fluid Therapy statistics & numerical data
Fluid Therapy trends
Health Policy trends
Subjects
Details
- Language :
- English
- ISSN :
- 1741-7015
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC medicine
- Publication Type :
- Academic Journal
- Accession number :
- 33342436
- Full Text :
- https://doi.org/10.1186/s12916-020-01857-7