Diarrhea is the second leading cause of death in children below five years of age globally and accounts for nearly 525 000 deaths in this age group every year. It is also the top cause of malnutrition in children under five.¹

Diarrhea increases the risk of dehydration, which is a prominent cause behind diarrheal deaths.^1,2 The condition can be prevented and adequately treated.¹ Diarrhea can be prevented through safe drinking water, enhanced sanitation, adequate hand washing with soap, exclusive breastfeeding for the first six months of life, practicing food hygiene as well as good personal hygiene practices, and rotavirus vaccination.¹

The key to treat diarrhea is rehydration with oral rehydration solution (ORS).¹ ORS, a mixture of water, salt and sugar, can play a potential role in dramatically reducing deaths in children due to dehydration.² ORS and zinc are crucial for the reduction of diarrhea related mortality.³

However, the coverage of ORS continues to remains low. Household surveys conducted over the years, such as the NFHS-2, NFHS-3, DLHS-2, and DLHS-3, have shown that ORS use was unchanged in Indian states of Uttar Pradesh and Gujarat from 1998 to 2007. According to the surveys, ORS coverage in Gujrat was estimated as 29% in 1998, 24% in 2002, 26% in 2005, and 37% in 2007. While it looks like there was an increase in ORS coveragein 2007, secondary analysis revealed that it was not statistically different from the estimates of previous years. In Uttar Pradesh as well, ORS coverage appeared to have no change. It was 16% in 1998, 15% in 2002, 13%in 2005, and 17% in 2007.⁴

Recently, a comparative analysis of two Demographic Health Survey (DHS) cycles evaluating the changes in ORS coverage in Zimbabwe, Zambia and Malawi noted that the coverage increased in Zimbabwe, appeared to be stalled in Zambia, and had fallen in Malawi.²

Investigators made use of a stratified two-stage cluster sampling design to draw the study sample. Primary sampling units (PSUs) were identified first and a fixed number of households was then selected from each PSU. National and sub-regional prevalence of ORS use was assessed during a recent episode of diarrhea, within 2 weeks of survey, with the help of DHSs for two different periods – 2007-2010 and 2013-2016.

Crude ORS coverage was found to increase from 21.0% in 1st Period to 40.5% in 2nd Period in Zimbabwe. It surged from 60.8% to 64.7% in Zambia, but demonstrated a decline from 72.3% to 64.6% in Malawi. The rates of change in ORS coverage among different provinces in Zimbabwe varied from 10.3% in Midlands to 44.2% in Matabeleland South. In Zambia, it ranged from -9.5% in Eastern Province to 24.4% in Luapula. In Malawi it varied from -16.5% in the Northern region to -3.2% in Southern region.The odds ratios (aOR) for ORS use was 3.95 for Zimbabwe, 2.83 for Zambia, and 0.71 for Malawi.

It is clear from the data that evaluation of national and province-level trends of ORS use can help us understand the geographic inequalities in ORS coverage and can also assist in the detection of area where resource allocation is needed. Health policies can hence be devised to advance the access to the required treatments in such areas.

References

1. Diarrhoeal disease. Available from: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease#:~:text=Diarrhoeal%20disease%20is%20the%20second,and%20adequate%20sanitation%20and%20hygiene. Accessed on December 16, 2020.
2. Gona PN, Gona CM, Chikwasha V, et al. Oral rehydration solution coverage in under 5 children with diarrhea: a tri-country, subnational, cross-sectional comparative analysis of two demographic health surveys cycles. BMC Public Health 2020;20, Article number: 1716.
3. Walker CLF, Fontaine O, Young MW, Black RE. Zinc and low osmolarity oral rehydration salts for diarrhoea: a renewed call to action. Bulletin of the World Health Organization 2009;87:780-786.
4. Lam F, Pro G, Agrawal S, et al. Effect of enhanced detailing and mass media on community use of oral rehydration salts and zinc during a scale-up program in Gujarat and Uttar Pradesh. J Glob Health. 2019 Jun; 9(1): 010501.