Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis

Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. W...

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Published in:	PLoS medicine Vol. 8; no. 3; p. e1000428
Main Authors:	Walker, Christa L. Fischer, Friberg, Ingrid K., Binkin, Nancy, Young, Mark, Walker, Neff, Fontaine, Olivier, Weissman, Eva, Gupta, Akanksha, Black, Robert E.
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 01.03.2011 Public Library of Science (PLoS)
Subjects:	Antibiotics Breast Feeding Breastfeeding & lactation Care and treatment Child, Preschool Children & youth Costs Costs and Cost Analysis Developing countries Diarrhea Diarrhea - economics Diarrhea - mortality Diarrhea - prevention & control Diarrhea - therapy Drinking water Epidemiologic Methods Gastroenterology and Hepatology/Gastrointestinal Infections Global Health Humans Hygiene Immunization Infectious Diseases/Epidemiology and Control of Infectious Diseases Infectious Diseases/Gastrointestinal Infections Intervention LDCs Low income groups Methods Mortality Patient outcomes Pediatrics and Child Health Per capita Prevention Public Health and Epidemiology/Health Policy Public Health and Epidemiology/Infectious Diseases Viruses Water quality management United States United States > US Costs & Cost Analysis Epidemiologic Methods Humans Breast Feeding Child, Preschool Diarrhea World Health
ISSN:	1549-1676, 1549-1277, 1549-1676
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Abstract	Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions. Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015.
AbstractList	Background Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. Methods and Findings We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions. Conclusion Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015. Please see later in the article for the Editors' Summary Background: Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. Methods and Findings: We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US $12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$ 84.8 billion would be required for the addition of all water and sanitation interventions. Conclusion: Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015. Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated.BACKGROUNDDiarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated.We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions.METHODS AND FINDINGSWe use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions.Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015.CONCLUSIONUsing currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015. Background Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. Methods and Findings We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions. Conclusion Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015. Please see later in the article for the Editors' Summary Using the Lives Saved Tool (LiST) Christa Fischer-Walker and colleagues estimate that scale-up of diarrhea prevention and treatment interventions over 5 years in 68 high child mortality countries could avert nearly 5 million deaths. Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions. Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015.
Audience	Academic
Author	Binkin, Nancy Fontaine, Olivier Walker, Neff Gupta, Akanksha Black, Robert E. Young, Mark Walker, Christa L. Fischer Weissman, Eva Friberg, Ingrid K.
AuthorAffiliation	4 Futures Institute, Glastonbury, Connecticut, United States of America 1 Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America 2 Health Section, Programme Division, United Nations Children's Fund (UNICEF), New York, New York, United States of America 3 World Health Organization (WHO), Department of Child and Adolescent Health, Geneva, Switzerland Institute of Child Health, United Kingdom
AuthorAffiliation_xml	– name: 2 Health Section, Programme Division, United Nations Children's Fund (UNICEF), New York, New York, United States of America – name: 4 Futures Institute, Glastonbury, Connecticut, United States of America – name: 1 Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America – name: 3 World Health Organization (WHO), Department of Child and Adolescent Health, Geneva, Switzerland – name: Institute of Child Health, United Kingdom
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Copyright	COPYRIGHT 2011 Public Library of Science 2011 Fischer Walker et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Walker CLF, Friberg IK, Binkin N, Young M, Walker N, et al. (2011) Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis. PLoS Med 8(3): e1000428. doi:10.1371/journal.pmed.1000428 Fischer Walker et al. 2011
Copyright_xml	– notice: COPYRIGHT 2011 Public Library of Science – notice: 2011 Fischer Walker et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Walker CLF, Friberg IK, Binkin N, Young M, Walker N, et al. (2011) Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis. PLoS Med 8(3): e1000428. doi:10.1371/journal.pmed.1000428 – notice: Fischer Walker et al. 2011
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Keywords	Costs & Cost Analysis Epidemiologic Methods Humans Breast Feeding Child, Preschool Diarrhea World Health
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Snippet	Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea... Background: Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual... Background Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual... Using the Lives Saved Tool (LiST) Christa Fischer-Walker and colleagues estimate that scale-up of diarrhea prevention and treatment interventions over 5 years... BACKGROUND: Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual... Background Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual...
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SubjectTerms	Antibiotics Breast Feeding Breastfeeding & lactation Care and treatment Child, Preschool Children & youth Costs Costs and Cost Analysis Developing countries Diarrhea Diarrhea - economics Diarrhea - mortality Diarrhea - prevention & control Diarrhea - therapy Drinking water Epidemiologic Methods Gastroenterology and Hepatology/Gastrointestinal Infections Global Health Humans Hygiene Immunization Infectious Diseases/Epidemiology and Control of Infectious Diseases Infectious Diseases/Gastrointestinal Infections Intervention LDCs Low income groups Methods Mortality Patient outcomes Pediatrics and Child Health Per capita Prevention Public Health and Epidemiology/Health Policy Public Health and Epidemiology/Infectious Diseases Viruses Water quality management
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Title	Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis
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