Journal Article

Oral rehydration therapies in Senegal, Mali, and Sierra Leone: a spatial analysis of changes over time and implications for policy

Troeger, Christopher E., Reiner, Robert C., Khalil, Ibrahim A., Lindstedt, Paulina A., Mokdad, Ali H., Ndoye, Babacar, Ogbuanu, Ikechukwu U., Farag, Tamer, Larson, Heidi J., Cook, Aubrey J., Johnson, Kimberly B., Schaeffer, Lauren E., Cormier, Natalie M., Mayala, Benjamin K., Sow, Samba O., Blacker, Brigette F., Welgan, Catherine A., Earl, Lucas, Kinyoki, Damaris K., Daoud, Farah, LeGrand, Kate E., Sartorius, Benn, Hay, Simon I., Bhutta, Zulfiqar A., Malta, Deborah C., Cain, Carrie Jo, Wiens, Kirsten E., Werdecker, Andrea, Baumann, Mathew M., Månsson, Johan C., Sankoh, Osman, Topor-Madry, Roman

2020

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Administration, Oral / Analysis / Bayesian analysis / Bicarbonates - therapeutic use / Biomedicine / Care and treatment / Child / Child Mortality - history / Child Mortality - trends / Child, Preschool / Children / Children & youth / Computational fluid dynamics / Dehydration / Diarrhea / Diarrhea - epidemiology / Diarrhea - therapy / Diarrhea in children / Fatalities / Female / Fluid Therapy - history / Fluid Therapy - methods / Fluid Therapy - statistics & numerical data / Fluid Therapy - trends / Forecasts and trends / Glucose - therapeutic use / Health care policy / Health policies / Health policy / Health Policy - history / Health Policy - trends / History, 20th Century / History, 21st Century / Humans / Infant / Male / Mali - epidemiology / Medicine / Medicine & Public Health / Oral rehydration solution / Oral rehydration therapy / Potassium Chloride - therapeutic use / Public health administration / Recommended home fluids / Rehydration / Research Article / Senegal - epidemiology / Severity of Illness Index / Sierra Leone - epidemiology / Sodium Chloride - therapeutic use / Spatial Analysis / Time Factors / Treatment Outcome / Trends / Viruses