Skip to search
Skip to main content
Back to Search
Start Over
Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17
Authors :
Kirsten E Wiens Paulina A Lindstedt Brigette F Blacker Kimberly B Johnson Mathew M Baumann Lauren E Schaeffer Hedayat Abbastabar, Sr 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 Adebayo Rufus Adesoji Adedoyin, Sr Victor Adekanmbi Olatunji O Adetokunboh, Sr 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, Sr Samiah Alam Genet Melak Alamene Turki M Alanzi Jacqueline Elizabeth Alcalde-Rabanal Beriwan Abdulqadir Ali Mehran Alijanzadeh Vahid Alipour Syed Mohamed Aljunid Ali Almasi, Sr Amir Almasi-Hashiani Hesham M Al-Mekhlafi Khalid A Altirkawi Nelson Alvis-Guzman Nelson J Alvis-Zakzuk Saeed Amini, Sr Arianna Maever L Amit, Sr Catalina Liliana Andrei, Sr Mina Anjomshoa Amir Anoushiravani, Sr Fereshteh Ansari Carl Abelardo T Antonio Benny Antony Ernoiz Antriyandarti Jalal Arabloo Hany Mohamed Amin Aref, Sr Olatunde Aremu Bahram Armoon Amit Arora, Sr Krishna K Aryal Afsaneh Arzani Mehran Asadi-Aliabadi Hagos Tasew Atalay Seyyed Shamsadin Athari, Sr Seyyede Masoume Athari Sachin R Atre Marcel Ausloos Nefsu Awoke Beatriz Paulina Ayala Quintanilla Getinet Ayano Martin Amogre Ayanore, Sr Yared Asmare Aynalem IV Samad Azari Peter S Azzopardi Ebrahim Babaee Tesleem Kayode Babalola Alaa Badawi, Sr Mohan Bairwa Shankar M Bakkannavar Senthilkumar Balakrishnan Ayele Geleto Bali Maciej Banach, Sr Joseph Adel Mattar Banoub, Sr 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, Sr Derrick A Bennett, Sr Dessalegn Ajema Berbada Robert S Bernstein Anusha Ganapati Bhat, Sr Krittika Bhattacharyya, Sr 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, Sr Reinhard Busse, Sr Zahid A Butt Luis LA Alberto Cámera, Sr Ismael R Campos-Nonato, Sr Jorge Cano Josip Car Rosario Cárdenas Felix Carvalho, Sr Carlos A Castañeda-Orjuela, Sr Franz Castro Wagaye Fentahun Chanie, Sr Pranab Chatterjee Vijay Kumar Chattu Tesfaye Yitna Yitna Chichiabellu, Jr Ken Lee Chin, Sr Devasahayam J Christopher Dinh-Toi Chu Natalie Maria Cormier Vera Marisa Costa Carlos Culquichicon Matiwos Soboka Daba Giovanni Damiani, Sr Lalit Dandona Rakhi Dandona Anh Kim Dang Aso Mohammad Darwesh Amira Hamed Darwish Ahmad Daryani, Sr Jai K Das Rajat Das Gupta Aditya Prasad Dash Gail Davey Claudio Alberto Dávila-Cervantes Adrian C Davis, Sr Dragos Virgil Davitoiu Fernando Pio De la Hoz Asmamaw Bizuneh Demis Dereje Bayissa Demissie Getu Debalkie Demissie Gebre Teklemariam Demoz, Sr Edgar Denova-Gutiérrez, Sr Kebede Deribe, Sr Assefa Desalew Aniruddha Deshpande Samath Dhamminda Dharmaratne Preeti Dhillon Meghnath Dhimal Govinda Prasad Dhungana Daniel Diaz, Sr Isaac Oluwafemi Dipeolu Shirin Djalalinia Kerrie E Doyle Eleonora Dubljanin Bereket Duko Andre Rodrigues Duraes Mohammad Ebrahimi Kalan Hisham Atan Edinur, Sr Andem Effiong, Sr Aziz Eftekhari Nevine El Nahas Iman El Sayed Maysaa El Sayed Zaki Maha El Tantawi Teshome Bekele Elema I Hala Rashad Elhabashy, Sr Shaimaa I El-Jaafary Hajer Elkout Aisha Elsharkawy Iqbal RF Elyazar Aklilu Endalamaw Daniel Adane Endalew, Sr Sharareh Eskandarieh Alireza Esteghamati Sadaf Esteghamati, Sr Arash Etemadi Oluchi Ezekannagha Mohammad Fareed Roghiyeh Faridnia Farshad Farzadfar Mehdi Fazlzadeh Valery L Feigin, Sr Seyed-Mohammad Fereshtehnejad Eduarda Fernandes Irina Filip Florian Fischer Nataliya A Foigt Morenike Oluwatoyin Folayan, Sr Masoud Foroutan Richard Charles Franklin Takeshi Fukumoto Mohamed M Gad Reta Tsegaye Gayesa Teshome Gebre, Sr Ketema Bizuwork Gebremedhin Gebreamlak Gebremedhn Gebremeskel, Sr Hailay Abrha Gesesew Kebede Embaye Gezae Keyghobad Ghadiri, Sr Ahmad Ghashghaee Pramesh Raj Ghimire, Sr Paramjit Singh Gill, Sr 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, Sr Davide Guido Rafael Alves Guimarães Yuming Guo, Sr Rajeev Gupta Nima Hafezi-Nejad Dessalegn H Haile, Sr Gessessew Bugssa Hailu Arvin Haj-Mirzaian Arya Haj-Mirzaian Randah R Hamadeh Samer Hamidi Demelash Woldeyohannes Handiso Hamidreza Haririan, Sr 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, Sr 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, Sr Guoqing Hu Mohammedaman Mama Hussen Segun Emmanuel Ibitoye Ehimario U Igumbor, Sr Olayinka Stephen Ilesanmi Milena D Ilic Mohammad Hasan Imani-Nasab Usman Iqbal Seyed Sina Naghibi Irvani Sheikh Mohammed Shariful Islam Chinwe Juliana Iwu Neda Izadi, Sr Anelisa Jaca Nader Jahanmehr Mihajlo Jakovljevic Amir Jalali Achala Upendra Jayatilleke Ravi Prakash Jha Vivekanand Jha John S Ji, Sr Jost B Jonas Jacek Jerzy Jozwiak Ali Kabir Zubair Kabir, Sr Amaha Kahsay Hamed Kalani Tanuj Kanchan Behzad Karami Matin André Karch Mohd Anisul Karim Hamidreza Karimi-Sari Surendra Karki Amir Kasaeian Gebremicheal Gebreslassie Kasahun Yawukal chane Kasahun Habtamu Kebebe Kasaye Gebrehiwot G Kassa Getachew Mullu Kassa Gbenga A Kayode Ali Kazemi Karyani Mihiretu M Kebede Peter Njenga Keiyoro Abraham Getachew Kelbore, Sr Andre Pascal Kengne, Sr Daniel Bekele Ketema Yousef Saleh Khader Morteza Abdullatif Khafaie Nauman Khalid Rovshan Khalilov Ejaz Ahmad Khan, Sr Junaid Khan Md Nuruzzaman Khan I Muhammad Shahzeb Khan Khaled Khatab, Sr Amir M Khater Mona M Khater Maryam Khayamzadeh Mohammad Khazaei Salman Khazaei Mohammad Hossein Khosravi Jagdish Khubchandani Ali Kiadaliri Yun Jin Kim Ruth W Kimokoti Adnan Kisa Sezer Kisa Niranjan Kissoon, Sr Shivakumar KM Marulasiddaiah M KMShivakumar, Sr Sonali Kochhar Tufa Kolola, Sr Hamidreza Komaki Soewarta Kosen Parvaiz A Koul Ai Koyanagi Moritz U G Kraemer Kewal Krishan Nuworza Kugbey G Anil Kumar Manasi Kumar, Sr Pushpendra Kumar Vivek Kumar Dian Kusuma Carlo La Vecchia Ben Lacey Sheetal D Lad Dharmesh Kumar Lal Felix Lam Faris Hasan Lami, Sr Prabhat Lamichhane Van Charles Lansingh Savita Lasrado Avula Laxmaiah Paul H Lee, Sr Kate E LeGrand Mostafa Leili Tsegaye Lolaso Lenjebo Cheru Tesema Leshargie, Sr Aubrey J Levine Shanshan Li, Sr Shai Linn Shiwei Liu Simin Liu Rakesh Lodha Joshua Longbottom Jaifred Christian F Lopez Hassan Magdy Abd El Razek Muhammed Magdy Abd El Razek D R Mahadeshwara Prasad Phetole Walter Mahasha, Sr Narayan B Mahotra Azeem Majeed Reza Malekzadeh, Sr Deborah Carvalho Malta Abdullah A Mamun, Sr Navid Manafi, Sr Ana Laura Manda Narendar Dawani Dawanu Manohar Mohammad Ali Mansournia Chabila Christopher Mapoma Joemer C Maravilla Gabriel Martinez, Sr Santi Martini Francisco Rogerlândio Martins-Melo Anthony Masaka Benjamin Ballard Massenburg Manu Raj Mathur Benjamin K Mayala Mohsen Mazidi Colm McAlinden Birhanu Geta Meharie Man Mohan Mehndiratta, Sr Kala M Mehta Tefera C Chane Mekonnen Gebrekiros Gebremichael Meles Peter T N Memiah Ziad A Memish, Sr Walter Mendoza Ritesh G Menezes Seid Tiku Mereta Tuomo J Meretoja, Sr Tomislav Mestrovic Bartosz Miazgowski Kebadnew Mulatu Mihretie, Sr Ted R Miller GK Mini Erkin M Mirrakhimov Babak Moazen Bahram Mohajer Amjad Mohamadi-Bolbanabad Dara K Mohammad Karzan Abdulmuhsin Mohammad Yousef Mohammad Naser Mohammad Gholi Mezerji Roghayeh Mohammadibakhsh Noushin Mohammadifard Jemal Abdu Mohammed, Sr Shafiu Mohammed Farnam Mohebi Ali H Mokdad Mariam Molokhia Lorenzo Monasta Yoshan Moodley, Sr Catrin E Moore, Sr Ghobad Moradi Masoud Moradi Mohammad Moradi-Joo Maziar Moradi-Lakeh Paula Moraga Linda Morales Ilais Moreno Velásquez Abbas Mosapour Simin Mouodi Seyyed Meysam Mousavi Miliva Mozaffor I Kindie Fentahun Muchie, Sr Getahun Fentaw Mulaw, Sr Sandra B Munro Moses K Muriithi Christopher J L Murray GVS Murthy Kamarul Imran Musa Ghulam Mustafa, Sr Saravanan Muthupandian, Sr Ashraf F Nabhan Mehdi Naderi Ahamarshan Jayaraman Nagarajan Kovin S Naidoo Gurudatta Naik Farid Najafi Vinay Nangia, Sr Jobert Richie Nansseu Bruno Ramos Nascimento, Sr Javad Nazari Duduzile Edith Ndwandwe, Sr Ionut Negoi, Sr Henok Biresaw Netsere Netsere, Sr Josephine W Ngunjiri, Sr Cuong Tat Nguyen Huong Lan Thi Nguyen Trang Huyen Nguyen Dabere Nigatu Solomon Gedlu Nigatu Dina Nur Anggraini Ningrum Chukwudi A Nnaji Marzieh Nojomi Vuong Minh Nong Ole F Norheim, Sr Jean Jacques Noubiap Soraya Nouraei Motlagh Bogdan Oancea Okechukwu Samuel Ogah Felix Akpojene Ogbo In-Hwan Oh Andrew T Olagunju Tinuke O Olagunju Bolajoko Olubukunola Olusanya Jacob Olusegun Olusanya Obinna E Onwujekwe, Sr Eyal Oren Doris V V Ortega-Altamirano, Sr Osayomwanbo Osarenotor Frank B Osei, Sr Mayowa O Owolabi Mahesh P A, Sr Jagadish Rao Padubidri Smita Pakhale Sangram Kishor Patel Angel J Paternina-Caicedo, Sr Ashish Pathak, Sr George C Patton Deepak Paudel, Sr Kebreab Paulos, Sr Veincent Christian Filipino Pepito Alexandre Pereira Norberto Perico Aslam Pervaiz Julia Moreira Pescarini Bakhtiar Piroozi Meghdad Pirsaheb Maarten J Postma Hadi Pourjafar Farshad Pourmalek, Sr Akram Pourshams Hossein Poustchi Sergio I Prada, Sr Narayan Prasad Liliana Preotescu Hedley Quintana Navid Rabiee Amir Radfar Alireza Rafiei Fakher Rahim Afarin Rahimi-Movaghar Vafa Rahimi-Movaghar Mohammad Hifz Ur Rahman Muhammad Aziz Rahman SHAFIUR Rahman Fatemeh Rajati, Sr Saleem Muhammad Rana, Sr Chhabi Lal Ranabhat Davide Rasella David Laith Rawaf Salman Rawaf, Sr Lal Rawal Wasiq Faraz Rawasia Vishnu Renjith Andre M N Renzaho, Sr Serge Resnikoff, Sr Melese Abate Reta Negar Rezaei Mohammad sadegh Rezai Seyed Mohammad Riahi Ana Isabel Ribeiro Jennifer Rickard, Sr Maria Rios-Blancas Leonardo Roever Luca Ronfani Elias Merdassa Roro, Sr Jennifer M Ross Enrico Rubagotti Salvatore Rubino Anas M Saad Yogesh Damodar Sabde Siamak Sabour Ehsan Sadeghi, Sr Yahya Safari Roya Safari-Faramani Rajesh Sagar Amirhossein Sahebkar Mohammad Ali Sahraian S Mohammad Sajadi Mohammad Reza Salahshoor Nasir Salam, Sr Payman Salamati Hosni Salem Marwa R Rashad Salem I Yahya Salimi Hamideh Salimzadeh Abdallah M Samy Juan Sanabria, Sr Milena M Santric-Milicevic Bruno Piassi Sao Jose Sivan Yegnanarayana Iyer Saraswathy Kaushik Sarkar, Sr Abdur Razzaque Sarker Nizal Sarrafzadegan I Benn Sartorius Brijesh Sathian Thirunavukkarasu Sathish Monika Sawhney Sonia Saxena, Sr David C Schwebel, Sr Anbissa Muleta Senbeta IV Subramanian Senthilkumaran Sadaf G Sepanlou Edson Serván-Mori, Sr Hosein Shabaninejad Azadeh Shafieesabet, Sr Masood Ali Shaikh Ali S Shalash, Sr Seifadin Ahmed Shallo Mehran Shams-Beyranvand MohammadBagher Shamsi Morteza Shamsizadeh Mohammed Shannawaz Kiomars Sharafi Hamid Sharifi Hatem Samir Shehata, Sr Aziz Sheikh B Suresh Kumar Shetty, Sr Kenji Shibuya, Sr Wondimeneh Shibabaw Shiferaw, Sr Desalegn Markos Shifti Mika Shigematsu Jae Il Shin Rahman Shiri, Sr Reza Shirkoohi Soraya Siabani Tariq Jamal Siddiqi Diego Augusto Santos Silva Ambrish Singh Jasvinder A Singh Narinder Pal Singh Virendra Singh Malede Mequanent Sisay Eirini Skiadaresi Mohammad Reza Sobhiyeh, Sr Anton Sokhan Shahin Soltani Ranjani Somayaji Moslem Soofi Muluken Bekele Sorrie, Sr Ireneous N Soyiri Chandrashekhar T Sreeramareddy Agus Sudaryanto Mu'awiyyah Babale Sufiyan, Sr Hafiz Ansar Rasul Suleria Marufa Sultana Bruno Fokas Sunguya Bryan L Sykes Rafael Tabarés-Seisdedos Takahiro Tabuchi Degena Bahrey Tadesse, Jr Ingan Ukur Tarigan Aberash Abay Tasew Yonatal Mesfin Tefera, Sr Merhawi Gebremedhin Tekle Mohamad-Hani Temsah Berhe Etsay Tesfay I Fisaha Haile Haile Tesfay Belay Tessema Zemenu Tadesse Tessema Kavumpurathu Raman Thankappan Nihal Thomas Alemayehu Toma Toma, Sr Roman Topor-Madry Marcos Roberto Roberto Tovani-Palone Eugenio Traini Bach Xuan Tran Khanh Bao Tran Irfan Ullah Bhaskaran Unnikrishnan Muhammad Shariq Usman, Sr Benjamin S Chudi Uzochukwu, Sr Pascual R Valdez Santosh Varughese, Sr Francesco S Violante, Sr Sebastian Vollmer, Sr Feleke Gebremeskel W/hawariat, Sr Yasir Waheed Mitchell Taylor Wallin Yafeng Wang Yuan-Pang Wang Marcia Weaver Bedilu Girma Weji Girmay Teklay Weldesamuel Catherine A Welgan Andrea Werdecker Ronny Westerman, Sr Taweewat Wiangkham Charles Shey Wiysonge, Sr Haileab Fekadu Wolde, Sr Dawit Zewdu Wondafrash Tewodros Eshete Wonde, Sr Getasew Taddesse Worku, Sr Ai-Min Wu Gelin Xu Ali Yadollahpour Seyed Hossein Yahyazadeh Jabbari Tomohide Yamada, Sr Hiroshi Yatsuya Alex Yeshaneh Christopher Sabo Yilgwan Mekdes Tigistu Yilma Paul Yip, Sr Engida Yisma Naohiro Yonemoto, Sr Seok-Jun Yoon Mustafa Z Younis Mahmoud Yousefifard Hebat-Allah Salah A Yousof Chuanhua Yu Hasan Yusefzadeh Siddhesh Zadey Zoubida Zaidi Sojib Bin Zaman Mohammad Zamani Hamed Zandian Nejimu Biza Zepro Taddese Alemu Zerfu Yunquan Zhang Xiu-Ju George Zhao Arash Ziapour Sanjay Zodpey, Sr Yves Miel H Zuniga Simon I Hay Robert C Reiner, Jr
Source :
The Lancet Global Health, Vol 8, Iss 8, Pp e1038-e1060 (2020)
Publication Year :
2020
Publisher :
Elsevier, 2020.
Abstract
Summary: 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.
Details
Language :
English
ISSN :
2214109X
Volume :
8
Issue :
8
Database :
Directory of Open Access Journals
Journal :
The Lancet Global Health
Publication Type :
Academic Journal
Accession number :
edsdoj.0d576ec668324847bf35c9ee501e4ea4
Document Type :
article
Full Text :
https://doi.org/10.1016/S2214-109X(20)30230-8