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

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 o...

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Bibliographic Details
Published in:BMC medicine Vol. 18; no. 1; pp. 405 - 13
Main Authors: Wiens, Kirsten E., Schaeffer, Lauren E., Sow, Samba O., Ndoye, Babacar, Cain, Carrie Jo, Baumann, Mathew M., Johnson, Kimberly B., Lindstedt, Paulina A., Blacker, Brigette F., Bhutta, Zulfiqar A., Cormier, Natalie M., Daoud, Farah, Earl, Lucas, Farag, Tamer, Khalil, Ibrahim A., Kinyoki, Damaris K., Larson, Heidi J., LeGrand, Kate E., Cook, Aubrey J., Malta, Deborah C., Månsson, Johan C., Mayala, Benjamin K., Mokdad, Ali H., Ogbuanu, Ikechukwu U., Sankoh, Osman, Sartorius, Benn, Topor-Madry, Roman, Troeger, Christopher E., Welgan, Catherine A., Werdecker, Andrea, Hay, Simon I., Reiner, Robert C.
Format: Journal Article
Language:English
Published: London BioMed Central 21.12.2020
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
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
Mali
Senegal
Sierra Leone
Recommended home fluids
Oral rehydration solution
Diarrhea
Spatial analysis
Oral rehydration therapy
Geospatial modeling
Health policies
ISSN:1741-7015, 1741-7015
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Summary: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.
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ISSN:1741-7015
1741-7015
DOI:10.1186/s12916-020-01857-7