Geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries |
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Geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries

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Oral rehydration solution (ORS) – a form of oral rehydration therapy (ORT), has the potential to drastically reduce diarrhea-related child mortality. Additionally, a variety of recommended home fluids (RHF) are used as alternative forms of ORT.

The objective of a new study published in The Lancet. Global Health was to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF and ORT – use of either ORS or RHF, in low-income and middle-income countries (LMICs).

In this study, a Bayesian geostatistical model was used to estimate annual proportions of children younger than 5 years, with diarrhea, who received ORS or RHF or both, on continuous continent-wide surfaces between 2000-17. In addition, geographical inequality in coverage across administrative units was calculated and the number of diarrheal deaths averted by increased coverage over the study period was estimated.

The results showed that while ORS use among children with diarrhea increased in some countries during the study period, coverage remained below 50% in the majority (62•6%3) of second administrative-level units. An estimated 6 519 000 children with diarrhea were not treated with any form of ORT in 2017. Meanwhile, increased ORS use corresponded with lesser RHF usage in many locations—resulting in relatively constant overall ORT coverage from 2000 to 2017. An estimated 52 230 diarrheal deaths were averted by scaling up of ORS coverage between 2000 and 2017. ORS was uniformly distributed subnationally in some countries; however, within-country geographical inequalities persisted in others. For instance – 11 countries had at least a 50% difference in one of their units compared with the country mean.

It was inferred that over 50 years after the discovery that led to this simple, cheap and life-saving therapy, large gains in reducing mortality could be made by reducing geographical inequalities in ORS coverage.

Source: The Lancet. Global Health. 2020 Aug;8(8):e1038-e1060.

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