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

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.

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.

• Authors: Kirsten E Wiens, Lauren E Schaeffer, Samba O Sow, Babacar Ndoye, Carrie Jo Cain, Mathew M Baumann, Kimberly B Johnson, Paulina A Lindstedt, Brigette F Blacker, Zulfiqar A Bhutta, Natalie M Cormier, Farah Daoud, Lucas Earl, Tamer Farag, Ibrahim A Khalil, Damaris K Kinyoki, Heidi J Larson, Kate E LeGrand, Aubrey J Cook, Deborah C Malta, Johan C Månsson, Benjamin K Mayala, Ali H Mokdad, Ikechukwu U Ogbuanu, Osman Sankoh, Benn Sartorius, Roman Topor-Madry, Christopher E Troeger, Catherine A Welgan, Andrea Werdecker, Simon I Hay, Robert C Reiner Jr
• Journal: BMC medicine (BMC Med) Vol. 18 Issue 1 Pg. 405 (12 21 2020) ISSN: 1741-7015 [Electronic] England
• PMID: 33342436 (Publication Type: Historical Article, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Bicarbonates
• World Health Organization oral rehydration solution
• Sodium Chloride
• Potassium Chloride
• Glucose

Topics

• Administration, Oral
• Bicarbonates (therapeutic use)
• Child
• Child Mortality (history, trends)
• Child, Preschool
• Diarrhea (epidemiology, therapy)
• Female
• Fluid Therapy (history, methods, statistics & numerical data, trends)
• Glucose (therapeutic use)
• Health Policy (history, trends)
• 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