Childhood diarrhea deaths have declined more than 80% from 1980 to 2015, in spite of an increase in the number of children in low- and middle-income countries (LMIC). Possible drivers of this remarkable accomplishment can guide the further reduction in the current annual childhood deaths from diarrhea.

The aim of a recent study published in the Journal of Global Health was to determine the proximal drivers of the diarrhea mortality reduction.

This study used Lives Saved Tool, which models effects on mortality due to changes in coverage of preventive or therapeutic interventions or risk factors, for 50 LMIC.

The findings revealed that diarrhea treatment – the use of ORS, zinc, antibiotics for dysentery and management of persistent diarrhea, along with rotavirus vaccination accounted for 49.7% of the diarrhea mortality reduction from 1980-2015. While improvements in nutrition – stunting, wasting, breastfeeding practices and vitamin A supplementation rendered 38.8% diarrhea mortality reduction and improvements in water, sanitation and handwashing accounted for 11.5% reduction. It was noted that the contribution of ORS was greater from 1980-2000 (58.0% of the reduction) than from 2000 to 2015 (30.7%). The coverage of ORS increased from zero in 1980 to 29.5% in 2000 and more slowly to 44.1% by 2015.

In inference, it was stated that to eliminate the remaining childhood diarrhea deaths globally, all these interventions will be needed. Scaling up diarrhea treatment and rotavirus vaccine to 90% coverage could reduce global child diarrhea mortality by 74.1% from 2015 levels by 2030. Adding improved nutrition could increase it further, to 89.1%. Additionally, adding increased use of improved water sources, sanitation and handwashing could cause a 92.8% reduction from the 2015 level. Thus, employing the interventions that have resulted in such a large reduction in diarrhea mortality in the last 35 years can virtually eliminate remaining childhood diarrhea deaths by 2030.

Source: Journal of Global Health. 2019 Dec;9(2):020801. doi: 10.7189/jogh.09.020801.